New Government even more pro Homeopathy!

The Prime Minister has given the job of Secretary of State for Health to Jeremy Hunt.  Health ministers (one rung lower than health secretary) Mike O’Brien (Labour) and Ann Milton (Coalition) have endorsed the British public’s right to NHS homeopathy. Mr Hunt goes further. Not only does he uphold the right of the taxpayer to choose NHS homeopathy, he has made his personal support for NHS homeopathy crystal clear.

Mr Hunt signed an early day motion in 2007 (EDM 1240) which salutes the positive contribution made to the health of the nation by the NHS homeopathic hospitals. Thank you Secretary for Health. We are happy to be of service.

Answering a letter to an anti-homeopathic constituent, Mr Hunt wrote: Homeopathic care is enormously valued by thousands of people and in an NHS that the Government repeatedly tells us is “patient-led” it ought to be available where a doctor and patient believe that a homeopathic treatment may be of benefit to the patient. (See here for details of the EDM and the letter)  Yes, Mr Hunt, that is the absolute crux of this issue – and not what the Disciples of Scientism and the “I know better than you what’s good for you brigade” would impose on the people of this island.

This is superb news for NHS homeopathy and it came as no surprise as the anti-homeopathic press went apoplectic with rage at his appointment.  But what exactly do they dislike about his statement about the NHS being ‘patient led’?

Nobody is forced either to receive or practise homeopathy on the NHS. Mr Hunt has not only stated his personal support for homeopathy; he has shown that he has some respect for liberty and democracy.

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Comments

Hunt is a hero! Delighted to hear this news Dr. K. You have worked v hard to defend our rights and I appreciate that.

A Hero? Or a mollusc in a coma?

The Mirror have quite an interesting slant on your hero.

“He is, without doubt, the thickest man in a suit that I’ve ever had a conversation with.

“There is ­nothing ­going on behind the eyes. It’s like trying to get through to a mollusc in a coma.”

http://www.mirror.co.uk/news/uk-news/why-jeremy-hunt-as-health-secretary-is-such-a-sick-1306533

Andy Lewis, you sure have some ‘interesting’ ideas about the players in this debate.

Let me get this right:
1. Health Ministers: O’Brien and Milton: (who supported NHS homeopathy) You obviously don’t think much of them.
2. New Sec. State for Health Hunt: well you say it all above
3. The Tabloid Press: good contribution when they agree with you
4. Me, Dr Brian Kaplan: medical doctor (MBBCh) and fellow of the Faculty of Homeopathy: not a serious player in this debate.
5. You Andy Lewis: Obviously a major commentator on these issues despite:
NO medical degree
NO training/experience in homeopathy or any other form of healthcare as far as I know

Your low qualifications in this area were highlighted by Ruth on these pages when she clearly pointed out to you the weaknesses of applying normal Gaussian curve statistics to medical/biological models. But you really do have to be a doctor to understand this. Decades of clinical experience do actually count for something in this debate.

Dr Kaplan

Thank you for sharing your guesses about my qualifications here. And for also your opinions as to why I cannot comment on homeopathy.

But perhaps we can get back to Jeremy Hunt and the politics of homeopathy – your favourite subject.

On the hpathy web site today, we saw Cloe Foss, a Welsh homeopathy, describe how she treated a case of endometriosis and a right-sided ovarian cyst with Hedgehog.

questions:

1) Do you think Jeremy Hunt would be correct to encourage to freedom of choice exercised here in a person with obvious serious medical problems being treated by a homeopath?

2) And, as a matter of interest, do you agree with Chloe that Hedgehog was the correct remedy in this instance, or perhaps, something else, like Chocolate or the Light from Venus?

Curious, as ever,

Andy

Andy,
Re: your qualifications to take part in this debate after you have suggested (in my comments section) that I’m not a serious player.
I don’t know what your qualifications are. I’ve heard it said you are a mathematician but no confirmation of that so please enlighten me and my readers on this point. Please make it clear how your qualify as a serious commentator on these matters.

On the treatment of endometriosis: It is a chronic condition that is quite a challenge for anyone to treat. I think Mr Hunt and anyone else would be glad to hear that the patient got better. To most humane people, the positive result would be the most important thing about the case. I personally don’t use many of the stranger remedies but the result is what matters – whether it is by hypnosis, listening carefully to the patient or the actual homeopathic remedy is less important than the fact that healing was catalysed in the patient. You don’t get that and you probably never will.

All ‘professional’ Quackhunters *must begin* where the biggest, worst, costly and most prevalent (mal)practices exist…..orthodox medicine.

Ruth MD (from the inside)

Thanks Ruth,

We all know how true that is. Andy Lewis and co know it too, but their reasons for attacking CAM and homeopathy have got nothing to do with medicine or care about the nation’s health – or any nation’s health for that matter.

Hey Ruth, What do you think about the ways prescription drugs are advertised to patients in the good ole USA? It seems that the aim of these ads is to hoodwink patients into pressurizing their doctors into prescribing drugs the patients have been convinced will be good for them – by the pharmaceutical company’s advertisements. That’s pretty vile imo. Patients could get useful stuff off the internet, but from advertisements? Oy!

Jeremy Hunt is an ideal person to promote homeopathy – there is nothing effective in either of them.

Perhaps Ruth would like to explain why Quackhunters *must begin* with ‘orthodox medicine’? That is a not a self-evident truth.

Firstly, there is a lot of effort from within real medicine in exposing shortcomings, failures and fraud.

I see no evidence of that taking place within homeopathy. Indeed, Dr Kaplan refused to look critically at the case of Chloe Foss and her magical Hedgehogs. One does not need a PhD in magichedgehogology to know that she is very much disconnected from the real world. And shamefully, Dr Kaplan, makes excuses for her.

Andrew,

‘Self-evident’?’
What is it about the sentence that you don’t understand?
Hunters generally follow the biggest prey.

Enjoy your food fights, but you cannot bait me since you are now on ‘ignore’.

Ruth.

Yes, Brian, the prescription advertising (‘pull-through’) is quite disgusting and counter-productive. The propaganda is intense and the consequences are negative.
Big Pharma spends more money on marketing than R&D.

Ruth.

Andy: you have not provided any answer about your qualifications: what have you got to hide? may be you do not have any?

Ruth – perhaps you would like to supply me with your ranked lists of all the injustices, errors and faults in medicine, or indeed the world, and be sure to place homeopathy on there with a big star nest to it so that I know when it is OK for me discuss homeopathy because the other problems have been solved.

That would be very kind of you.

By the way, the biggest homeopathy company, Boiron, a billion dollar company, spends nearly 20 as much on marketing than R&D-a ratio that would make any Big Pharma company blush.

Amazing and horrific. If people like Andy Lewis really cared about ill people they would focus their attention on this scandalous fact. Any self-respecting and unbiased commentator on health would do what all investigative journalists would do: Follow the money. The small amount of money spent on homeopathy in the NHS is miniscule in relation to the sort of money you are talking about. ‘More money on marketing that R&D’. As I’ve said before: I believe very few of NHS homeopathy’s detractors care about the nation’s health. eg: Budget for homeopathic meds on NHS is 10 million pounds. Budget for controversial SSRI anti-depressants alone: 32 million pounds.

Q: So if they don’t care about the nation’s health, what do these people care about then?
A: The sheer affront that the popularity of homeopathy and CAM bring to their exclusively mechanistic and deterministic view of the universe and their commitment to an authoritarian political position to enforce those views on a public too stupid/naive/gullible to be able to choose for themselves. The very same public at whom all Big Pharma’s advertisements for prescription drugs are aimed.

I make excuses for nobody. I don’t allow myself to be drawn away from the subject of my posts by your less than subtle segways into your own rather boring territory.

Sounds like a perfectly reasonable question to me, Andy.

Subjective opinions are welcome here too.

Brian – hedghog – as a cure. Diluted. In a magical way.

This was not a “segway”. It was to explore if there are any limits on your ‘personal choice’ agenda and to test your sudden support for Jeremy Hunt to see if this is the sort of thing you would encourage – as a registered medical practitioner.

And amadis -Kaplan brings up my qualifications as a way of avoiding discussing very obvious problems in homeopathy and his choice agenda. Perhaps you could tell me in your opinion what the minimum level qualification is for discussing scientific and ethical issues in the practice of homeopathy?

I’ll take that answer as ‘no medical qualifications’ Andy Lewis. Until we hear otherwise from him of course. But of course he considers himself a player in this debate, but not me. What a joke!

I find it amusing you try to accuse me of ‘drawing away’ the debate from the subject of the post when this is the only tactic you haveto defend silly views about homeopathy and politics. Your position on my qualifications is exactly that. They have no bearing on whether Jeremy Hunt should be encouraging people to see untrained people who believe magic hedgehog can cure serious illness.

By the way, Brian, what scientific credentials do you have? And as I have asked, what are the what the minimum level qualification is for discussing scientific and ethical issues in the practice of homeopathy?

If you can give a reasonable and defendable answer to that, and I fall short, I will shut up.

I would also like to comment on how I find it bizarre that you are all for ‘democracy’ and libertarianism when it comes to the choice of medical therapies that people use, but are completely authoritarian when it comes to choices about what people can discuss. Apparently, we can only discuss issues that are about conventional medicine and only discuss homeopathy if we have achieved some unstated level of qualification.

Would you like to address this contradiction in your libertarian stance?

the reason your qualifications are an issue, is because you do make definitive statement on medicine, homeopathy etc, you say you are right, and they are wrong; i have no qualification in either medicine or homeopathy, so I feel free to join the debate, and entitled to give my modest opinion; in you case, you pretend to be in a position to prove doctors or homeopath wrong, it is only right to question your qualifications and background, in order to know if you are to be taken seriously or if you are just bullshitting everybody.
So my question again: what is your background, and your qualifications? this will give me some idea if you know anything about medicine, homeopathy, etc.

Are you serious Andy?

Of course you are entitled to discuss whatever you want whenever you want – on your blog. You are also welcome to comment on my blog even off the subject but don’t expect me to let you hijack the subject matter. In a democracy you do have to discuss and vote on the subject at hand, not always bring up your own hobby horse by finding ways to segway to it tangentially. We have discussed NHS homeopathy ad nauseum so I’m happy for people like Ruth to bring up serious issues in mainstream medicine.

Re: ‘only discuss homeopathy if we have achieved some unstated level of qualification.’ You must be joking. When I challenged you to a public debate on NHS homeopathy you said that I was the one who wasn’t a serious player in this debate. THAT is why I bring up qualifications. Up till then I regarded you as a worthy opponent, but when you said that, I did feel it appropriate to ask for your qualifications as a serious player in the debate.

No contradiction there at all. Just some serious psychological projection on your part.

PS: This post was about Jeremy Hunt’s previous remarks on homeopathy.

Bravo Amadis! Andy should not be ashamed to answer you reasonable question.

Just a quick contribution:

Ruth seems to be asserting that ‘professional quackhunters’ turn a blind eye to the problems within orthodox medicine? I’d regard Ben Goldacre as one of the most high-profile ‘professional quackhunters’, and am eagerly awaiting the publication of his next book, ‘Bad Pharma’. That doesn’t sound like someone who’s being one-sided in his interrogating important public health issues.

Dr Kaplan, I’m genuinely surprised that you disapprove of drug companies advertising directly to consumers? I’d see this as anti-libertarian, and has a whiff of the public not being able to decide for themselves what’s best for them? I should add that I also disapprove of drug companies behaving in this way, but because I probably don’t fit the definition of a true libertarian, and am happy to accept that the public don’t always know what’s in their best health interests.

Oh, and I’m not sure I understand the fascination with qualifications? Are we to disregard the most authoritative study into the ineffectiveness of anti-depressants for mild-moderate depression (and with it arguably the biggest exposé of big pharma publication bias), because the lead researcher was a clinical psychologist, and had never prescribed a psychiatric drug in his life?

Not sure what you think?

OK. So let me get this straight.

You blog about Hunt and his supposed support for homeopathy. I question the wisdom of Hunt and what you think his ideas of patient choice actually mean when there are people out there who believe in magic hedgehog. But somehow that is going off topic and ‘hijacking’ your blog,but my qualifications and teh evis of medicine are on topic.

I must admit I am confused.

It is not your qualifications (or mine) that make you not a serious player. It is your complete failure to engage with any of the criticisms of your own stance. You appear to be happy to deflect into any subject but what the implications are of your ‘freedom’stance for homeopathy.

Yes you are confused.

Yes, it’s true Ben Goldacre does this and that he is writing such a book is to his credit. However most of his colleagues among the anti-homeopathic skeptics are much more selective about whom and what they trash. ie they only attack homeopathy and CAM with nothing to say about Big Pharma. Pity about the embarrassing testimony he gave to the discredited S&T committee. But then again a doctor & journalist who went from absolutely nowhere in journalism to being a columnist in the Guardian, is not someone who should have been asked to testify. Maybe he can tell me how to get a column on the Guardian to express my views? ;-)

I do disapprove of ads for prescription drugs but I do not seek to outlaw them. Unlike the anti-libertarian opponents of NHS homeopathy. There is a big difference between disapproving of and seeking legislation against something that is not to your taste.

Thanks for that Dr Kaplan.

So you would dissaprove of, but not seek to outlaw, pharmaceutical companies advertising within the NHS – perhaps with manned stands at hospital entrances? I only throw in this curve-ball to learn the extent of your libertarianism, and confidence in the untrained public to know what’s in their best health interests. And also to learn whether you think state owned institutions like the NHS can be a special case for regulation.

By the way, you do know that Jeremy Hunt MP is a PPE graduate – so, by some’s reasoning, surely this would render him unqualified to comment authoritatively on homeopathy?

amadis – you make the fundamental mistake of believing the strength of any argument I make relies on what exams I have sat. I make no appeal as such.

My position should be judged purely on its own merits, the reasoning behind it the evidence for it. But if you notice on this blog, Dr Kaplan will go out of his way not to discuss the evidence. You may draw your own conclusions as to why that might be.

Dr Kaplan – still waiting what you feel are sufficient academic credentials to discuss homeopathy.

Dear Adzcliffe, You clearly have not worked in the NHS otherwise you would see how Big Pharma exerts its influence everywhere – for example by sponsoring huge educational seminars – some of which are quite good apart from the ‘manned stands’. Re: qualification: It is not I who disqualify people from discussing this. When Andy said that I was not a ‘serious’ player in this debate (as a way of declining my challenge to meet him in debate in public) I questioned what HIS qualifications were as a serious player.

Andy, you speak with authority about medicine, homeopathy, mathemathic, science, what is true, what is right; you are not simply giving an opinion, you want to debunk homeopathy and alternative medicine, you accuse medical doctors of being wrong for using homeopathy, or alternative medicine; what gives you such an authority, what makes you an such an expert in Randomised controlled Trial, and medicine, and homeopathy, and medical research, so spit it out! what are your qualifications? I find your reluctance to divulge this kind of information suspicious

‘Discussing the evidence’ is not the subject of this post but just for the record: I don’t discuss it because the key and most controversial point in it is the ‘cherry picking’ of meta-analyses and that is not my special interest. Critics of homeopathy accuse homeopathic doctors of cherry picking meta-analyses and vice versa. I am not interested in arguing that point and will leave the experts in those matters to debate it.

Okay:
To discuss the appropriate application of Gaussian curves to analyse results of clinical trials of homeopathy: MBBCh and Statistics 101. (You may not think so because I don’t think you have an MBBCh but if you did have an MBBCh you would understand why you really do need it!)

To discuss homeopathy as a pure subject: The Organon by Samuel Hahnemann

To discuss the code of ethics of doctors on the NHS who use homeopathy: The ethical code of the Faculty of Homeopathy should be read and an MBBCh is useful.

To discuss availability of homeopathy on NHS: On Liberty by John Stuart Mill is recommended.

To discuss why the authoritarian recommendations of the anti-homeopathic ‘skeptics’ undermine liberty: Hayek’s The Road to Serfdom is a good idea.

You bet Amadis!
Not only would we like to know his qualifications, we would like to know what motivates and incentivises him to do these things. Are we to believe it is altruism?

Thanks again Dr Kaplan.

I think you might have been a bit quick with your assertion there. Actually, I do see Big Pharma’s influence everywhere: ranging from the pens and stationary that infiltrate professional and public spaces – as to promote the ‘Sellotape’, ‘Blue Tack’ and ‘Hoover’ effect – to ghost-written papers, spurious educational leaflets and text-books, and advertisements in journals and magazines. My point is that you’ve raised an objection to attempts to keep homeopathy out of the NHS – i.e. going beyond vocal ‘disapproval’ – whilst not making completely clear if you’d regulate Big Pharma’s relationship with NHS patients? If I have you right, your libertarian values would only permit you to ‘disapprove’ of direct drug-marketing to NHS patients?

Re. your spat with Andy Lewis: I’ll need it pointing out to me if he’s a self-professed ‘serious player’, but would question whether the academic accreditation you’re seeking gets you any nearer to an answer. Let’s not forget that highly trained individuals have believed and practiced some crazy things, whilst other minds have come up with great ideas with little or no training. The litmus test for an idea is in the idea, and the evidence or logic behind that idea, not in what certificates people have stashed away in a drawer somewhere. Perhaps the personal nature of your ‘degree-off’ with Andy has lent you to inadvertently endorse some of your supporters’ thinking that the extent of someone’s qualifications has a proportional relationship with the extent of their authority. Perhaps it would be in their interests – and yours as an educator – to politely address this fallacy in their thinking? Not sure…

Sorry to be a pedant, but:

Samuel Hahnemann was not a ‘trained’ homeopath. If qualifications maketh the idea, why are his ideas to be listened to?

As far as I’m aware, John Stuart Mill never managed a degree in anything – why should he be regarded a player in discussions about liberty?

And, for the sake of balance, Wiki tells me that Friedrich Hayek was indeed an exceptionally well decorated academic, with qualifications in the very subjects he wrote about. By others’ reasoning, is he the only useful citation here?

Ta.

Dr Kaplan,

Let’s subject your criteria to a little critical analysis.

1) Not sure why you are fixated by Gaussian curves. Ruth never responded to my requests to clarify her handwaving. And while we are on the subject of Ruth, I understand she is in biotech. Do you too rule Ruth out from being able to discuss such things?

2) Not sure what homeopathy as a “pure subject” is. But in the organon there is no such thing as dream provings used on hedgehogs. Is Chloe ruled out of the discussion too?

3) Not sure why you need an MBBCh to understand ethics. Plenty of medical ethical philosophers around who do not.

4) So, you are onto recommended reading lists now. Are you the authority on setting such reading lists? What qualifications do you have in the area?

All this reminds me of the Emporer’s courtiers who insisted you were not allowed to critise his apparel unless you had an appropriate PhD in Invisible Imperial Textile Manufacture.

As homeopathy is not medical discipline but a set of superstitious, magical and cult-like beliefs, you will have to forgive me for not having any official qualifications in homeopathy.

Re: ‘objections to keeping (I guess you mean ‘gettting’) homeopathy out of the health service’: I have been entirely consistent. If there is to be an EBM standard, let’s hear what it is and all interventions would have to pass it. As I’ve written here before, this would devastate Big Pharma much more than it would harm homeopathy

Re: Andy Lewis: Of course he sees himself as a serious player in this debate. His blog almost exclusively attacks CAM and he clearly puts a lot of time into it and has written extensively in the comments section here.

Re: qualifications: Okay let me be clear. ANYONE is free to comment, but when people (like Andy Lewis) question my credentials as a player in this debate, I am certainly going to ask him for his qualifications. Note that before he insulted me like that, I had not asked him for his qualifications. I do think you need to be in the caring professions to have a say here. Andy has described doctors as ‘trained technicians’ (sic). All doctors would take exception to being termed thus. Thats where he makes a huge misconception about doctors. We are not foot soldiers for Medical Science. We are members of the caring professions and have to know something about human beings as well as anatomy and physiology. Anyone can comment on what happens in the clinic between patient and doctor but those who have not been involved in MANY such encounters, I personally think are less qualified to comment on these matters. This is not merely a matter of statistics and as Ruth has pointed out, there are problems with the ruthless mathematical application of Gaussian curves to medical and biological models. You need to be a doctor to see this imo.

Nor unofficial, nor any real knowledge of what happens in a consultation of classical homeopathic history taking, nor medical qualifications. So why don’t you tell us what qualifications you do have? Amadis and I are waiting….

So Freud should also be ignored because he didn’t have qualifications as a psychotherapist?
And Plato ignored because he didn’t have a degree in philosophy?

Pioneers cannot have degrees in their subject, Adzcliffe. Did I really need to point that out?

JS Mill was a philosopher who had certainly studied the philosophers before him.

Perhaps it is possible to comment on something without experience of it yourself but it is a rare thing. When I watch rugby it does seem that all the commentators used to play rugby themselves.

Thanks Dr Kaplan (you’ll bore of me soon).

I can see why you’re taking this tact having felt insulted, but his ‘playership’ isn’t defined by his university qualifications surely?? You won’t drop all your criticisms, and embrace his perspective were he to inconveniently pull some sort of medical sciences degree out of the bag? You’d just be amazed that he can be so wrong, whilst being so qualified? This would show his qualifications to be a distraction all along. Why not just make clear with your supporters that your ‘degree-off’ with him here is purely personal, and has no bearing on the legitimacy of his argument?

I’m not sure describing doctors as ‘trained technicians’ is necessarily as pejorative as you infer (although ‘highly trained specialist technicians’ might be more accurate). It might be similar to saying that not all lawyers are moral philosophers. Trainee medics and lawyers (amongst other professions) are selected (amongst other things) for their academic capabilities to process, understand and implement vast swathes of information. Whilst all non-cheats qualify having, at various stages, possessed impressive amounts of this highly technical knowledge, not all qualify with the skills or interest to understand the arcane intellectual principles or backgrounds behind how this knowledge came to be. Applying knowledge is one thing (technician), furthering and interrogating knowledge (scientist/philosopher) is quite another – in my opinion.

Oh, and I’ll think you’ll give me that it’s not only doctors that are able to make sense of applied statistics in healthcare, but any health professional who’s able to make sense of applied statistics in healthcare.

Just clarify, you wouldn’t regulate Big Pharma’s relationship with NHS patients?

No Dr Kaplan, you misunderstand me. I believe strongly that a valid contribution can be made towards any subject, despite having no specific training or qualifications in that subject. People can educate themselves in all sorts of ways (as did Mill). It’s ocassionally you, and mainly others on here who seem to be suggesting otherwise. So your personal issues aside, why do you think people are so focussed on qualifications here??

Re: ‘it’s not only doctors that are able to make sense of applied statistics in healthcare, but any health professional who’s able to make sense of applied statistics in healthcare.’ Yes, a health care professional. So if Andy is a health care professional, let him say so

Re: ‘not sure describing doctors as ‘trained technicians’ is necessarily as pejorative as you infer’
Ask a few doctors and see what they say. Yes you need technical training but to deal with people you need MUCH more than that. A philosopher needs mathematics but not only mathematics. Or to be facetious, as the Germans say: ‘To be a psychiatrist you need to be mad but that is not enough’

Re:Why not just make clear with your supporters that your ‘degree-off’ with him here is purely personal, and has no bearing on the legitimacy of his argument?
Yes fair enough. Adzcliff, I respected him enough as an opponent in this debate and challenged him to a live debate. He refused because he thought I was not a serious player in this debate. This triggered a discussion about the ‘qualifications’ of a serious player in this debate and clearly academic qualifications, while not a sine qua non, are of relevance here. However I’m not sure of the real reasons for him refusing to meet me in live debate. A certain poultry-related word comes to mind.

Yeah, sorry, I was actually making a point about medic-centrism in healthcare (i.e. as the only profession able to understand X, Y, Z). I’d probably even drop healthcare professional for ‘anyone’ (if I’d spent 10 years of my non-work life absorbed in the medical sciences, I believe I’d have something worth saying on the topic – bordering on expertise – even if I lacked a feel for how some of the issues and challenges might play out in real life). Will give you a break for this evening – thanks for your time.

The reason I questionned andy’s qualifications, is because he present himself as the “debunker” of homeopathy, and the defender of Evidence Based Medicine; i would have thought that to be so categorical in his statement, he would at least have some qualifications in medicine, EBM or homeopathy or all three. He often mention on his blog the value of critical thinking: fair enough, this is a useful approach and I am certainly not against it, unfortunately, it can also be developed into a technique to win (apparently) arguments and display false competences in any subjects; I believe the real skills and qualifications of Mr Lewis are very much in this kind of distortion of critical thinking, one can see in his responses and lack of, a clear strategy of some kind of intellectual bullying of opponents into submission, rather that contributing creatively to an intelligent debate.
I am not a scientist, nor an homeopath, I am just using a little common sense to see through a lot of rubbish

I realise that my comments are off topic, but I cannot let this intellectual bullying, and gross distortion of the debate go on without saying anything; so Andy, beside an obvious compulsion to always win argument, do you have any qualification and competence in homeopathy? clinical medicine? patient management? Evidence Based Medicine? or is it OCD? i am curious and open minded, let us know

I think it is worth pointing out that the phrase “trained technician” was not my own. I had been recently having a drink with a FRCS who described doctors thus- making the point that medical training was not a scientific training. Doctors are not trained to be scientists – they are trained to carry out the highly technical act of being a doctor.

Dr Kaplan has admitted just as much that he is not familiar with RCTs and their methods. Or is that just to avoid discussing them?

Amadis, you have a gut instinct for the real ‘game’ going on here. Have a look here at an excellent lecture on the subject by an Australian professor of medicine (very orthodox scientific medicine that is), Paul Komesaroff and published in the Australian Medical Journal. He concludes with these sage words:

‘In the spirit and tradition of science, if there is a disagreement, let it be resolved in the crucible of public discourse. We do not need intellectual vigilantes patrolling the corridors of our institutions looking for theories or ideas with which they disagree to drive them out from our midst.’

To my mind, Andy is exactly one of ‘patrolling intellectual vigilantes’ and his view that homeopathy should be removed from the NHS fits the description above perfectly. I asked him straight in this comments section if he would agree that he is indeed such. Needless to say I did not get an answer – as you probably will not get to your request for his qualifications.

If you say something you own it. Otherwise attribute it to someone else. However it is true that surgeons are closer to ‘trained technicians’ than most other doctors but even they would feel insulted at being described as such. Of course I’m ‘familiar’ with RCTs and I’ve reviewed the debate about cherry-picking meta-analyses of RCTs. Both sides accuse the other of cherry picking. Nevertheless more meta-analyses show homeopathy to be working than those that don’t. This is not an easy subject for the public to grasp – the cherry picking of meta-analyses. Deciding what constitutes a high quality RCT and then a high quality fair meta-analysis of many RCTs is a very sophisticated process and simply not my main interest, other than to say that looking at all the RCTs and meta-analyses, it seems there is more for homeopathy than against. Many others feel the same way about this.

Amadis

Not only is critical thinking a useful approach, it is the only approach to making sense of reality. Anyone who sets themselves up in debate as a ‘critical thinker’ is actively inviting rational argument and counter perspectives – not misappropriating a technique to ‘win’ anything. Also, why not just imagine Andy’s a well decorated biomedical academic with decades of relevant research and clinical experience? Do his arguments now seem anymore credible? If ‘no’, then I suggest you move on (this is a pointless distraction); if yes, I’d suggest you have too much respect for authority (focus on the argument, not the arguer).

Dr Kaplan.

I’ve not read the context of your Komesaroff quote, but don’t understand why you’d consider engaging in debate through internet discussion forums “patrolling the corridors of our institutions”, rather than the “crucible of public discourse”. Unless I’m missing something, I’d see it entirely in reverse?

Also, if you could just confirm whether you’d regulate Big Pharma’s relationship with NHS patients, it’d be appreciated (it’s difficult to know if your avoiding this question for an unknown reason, or whether you’re being side-tracked by more interesting things).

Ta.

Perhaps now is the time to return to the subject of Brian’s post which is the appointment of Jeremy Hunt to the position of Secretary of State for Health and what the implications might be for homeopathy. As an amateur follower of things political in the UK, my observations of this appointment are as follows:

Firstly, Jeremy Hunt is widely perceived, perhaps correctly, as one of Cameron’s Cronies. It may well be that the political errors associated with an apparent proximity to News International during the Sky TV shenanigans have meant the he has survived in office longer than would have been the case had he not been one of the Cronies. That said, he is also alleged to be the wealthiest member of the Cabinet, having made a considerable fortune before he came into politics. It is also fair to say that the management of the Olympics was carried out very efficiently, with only one minor glitch in the form of G4S. In the end, the whole thing, including the Para-Olympics, has been carried off extremely smoothly. I doubt if Hunt did much in the way of day-to-day management, but the fact is that he gathered the right people arround him to get a highly complex logistical operation successfully completed. And this suggests to me that he is in fact extremely switched on and capable of getting things done in the real world.

So, contrary to the assessment of the Daily Mirror, I suggest that there is a great deal going on behind Hunt’s eyes. It’s perhaps just that he is wise enough not to let journalists from a left wing tabloid see exactly what is happening.

The signing of Early Day Motions is something of a peculiar business within the House of Commons. There are all sorts of EDMs made and all sorts of MPs who sign in support of whatever opnion is put forward. In theory, if there is enough support for a subject, there is the possibility that an EDM is put forward as a subject for debate within the Commons chamber. In fact, nearly all EDMs stop dead in the water at that point. It is also a moot point as to whether a signature is indicative of an individual MP’s opinion on a matter. There are many instances where MPs have signed something in support and then voted against it in later debates. I suspect that if you looked at the fox hunting issue, for instance, you will find several such instances of MPs acting apparently in contradiction of earlier sentiments. It is not always hypocrisy, but demonstrative of the way in which politics in a democracy is a series of compromises with individual consciences and a succession of conflicting events.

So, having said that, my gut feeling is not to rely upon anything any MP has supported in an EDM, or upon what they may have said privately to one individual. The fact is that politics changes as events move on. I am not making excuses here for a profession held widely in contempt by most members of the public, merely that I am observing that this is what often happens.

I do not know if Jeremy Hunt is to the left, right or centre of the Conservative Party. My guess is that he is unlikely to be as radical as, say, Michael Gove in Education, Ian Duncan Smith in Social Services, or Liam Fox was in Defence. Which in many ways is a shame because the NHS has been in need of serious reform these last thirty years. It has become a vast, unwieldy and wasteful organisation, which (in some quarters at least) has forgotten what it is there for. If perhaps only 30% of the waste was cut out of the NHS, the government could, for instance, double the Defence budget whilst at the same time returning money to the taxpayer in the form of reduced taxation. Andrew Lansley held the Health brief in both government and opposition, for nearly a decade. In so doing he has run up against the powerful vested interests within the Health Service, including the BMA. Jeremy Hunt will find it hard going to get the change necessary to give the taxpayer what we all need and expect from a modern health service; whilst, at the same time, making it affordable.

So where does this leave homeopathy within the NHS? My comments amount to little more than a guess, but I suspect that Hunt’s natural instincts will be to leave things as they are. He has many, many other much bigger problems to deal with than the handful of £millions cost represented by homeopathy. If he is pressed on the issue, I hope he will look at those costs objectively; that he will also look at the patient satisfaction acheived by homeopathy (and many other forms of CAM); and that he will consider that those who wish to be treated by this form of medicine within the NHS will have their wishes respected. Such patients are taxpayers as much as anyone else, and their treatment does not deprive any other patient of urgent or competing medication.

It would be nice to think that he will stop the harassment of homeopathy within the medical professions and perhaps even encourage more research, but perhaps that is an argument for another day.

I’ve given a reference to the Komesaroff quote. Of course I support all discussions to be in ‘crucible of public discourse’. My point in quoting the Prof is to suggest that Andy Lewis is very much a ‘vigilante intellectual patrolling the corridors of our institutions’ to rid them of ideas they (the vigilantes) find objectionable. I am all for bringing the discussion into the ‘crucible of public discourse’ and that is why I challenged him to a live debate. He refused on the grounds that I’m not a serious player in this debate. THAT comment and that comment alone led to me questioning him about HIS qualifications as a serious player. Before that I regarded him in exactly the way you have suggested.

Of course there has to be SOME regulation of Big Pharma but there should be a level playing field of regulations for ALL interventions on the NHS. Is that so much to ask for? Nevertheless I don’t support over-regulated societies and point to the Weimar Republic as an example of one of the over-regulated societies of our time and guess where that led to?

All clear now?

Great to have you back, David. And what a pleasure to have a commentator talk specifically about the topic of a post rather than trying to segway their way into what they want to talk about. Yes, if ever there was a job that could break a man or make him PM, it is Sec of State for Health in these economic times. It is a HUGELY responsible position and a considerable test for the man. All we can do is wish him well.

Brian,

Being a “bear of little brain”, it took me some time to discover what exactly a Segway is. I now discover that you are using it as a verb. This cracks me up. You use it in a sense which suggests that it is a sneaky form of motion or manoeuvre. Is it something to do with the form of motion, or the kind of people who use one?

Sorry, but I just had to ask:)

Hi David,
It’s typical of modern political ‘discourse’. Pay lip service to what someone has said, find a segway (no matter how artificial or trite) to what you want to say, start your own discourse. This works well on the internet but not so well in public debate.

It is probably worth pointing out that Paul Komesaroff is an apologist for homeopathy, so he would say that, wouldn’t he?

And, I must say, that is is quite disingenuous not to point out that the Komesaroff quote was not made as some general pronouncemnet about discussing medical issues, but in response for calls for Australian universities not to teach the pseudosciences such as homeopathy.

As such, Komesaroff was playing exactly the same game that you do, Dr Kaplan.Instead of making a case that homeopathy is not a pseudoscience and should be taught, he tries to make a claim that his critics have no right to speak.

The more I discuss homeopathy, the more I see that this is homeopaths only remainin tactic – to somehow try to deny the legitimacy or right of their critics to be heard.

Nice game.

Thanks Dr Kaplan – much clearer.

I too believe that we can’t extend libertarian values to state-owned organisations such as the NHS, as one person’s freedoms might infringe another’s. Some regulation will always be necessary to balance everyone’s interests. The state funding of homeopathy is one of these very issues, as is Big Pharma marketing directly to NHS patients. We might disagree on where we draw the line on regulation, but to polarise the debate as libertarian democracy versus totalitarian paternalism (or whatever it is your ‘brigade’ stands for), in my view, isn’t helpful.

P.S. I also enjoyed David Eyles analysis of the political situation, and am probably with him that we may be wasting our time predicting what our new health secretary is thinking at this moment.

Over and out.

“Not only is critical thinking a useful approach, it is the only approach to making sense of reality.”
Not so Adzcliff!
You are confusing map and territory: the critical thinking allow you to establish a model, a representation of the reality, the yin yang model of the East, or say the reality as seen by the aborigines may be slightly different to your model; for them their understanding of reality is all what they need.
What is important is to avoid a confusion between the model ie: The map, by definition it is incomplete) and the territory: the reality represented by the map (by definition it cannot be grasped in its totality).
You, and Andy and a large number of skeptics are constantly pretending that the map is the territory, that you model of reality is the only way to grasp reality, and that it encompass all reality.
RCTs for example must focus on extremely limited criteria to be able to work, this is fine in for example establishing the effectiveness of a drug, and again it does not always do so. In medicine, so many factors play a part in getting somebody better, that it cannot simply be reduced to simplistic Evidence based Model.
Take a patient,and 5 doctors, they may reach the same diagnosis, but will develop different treatment strategies, and in the end, the doctor that the patient like more is likely to be most effective for this patient. Even if RCT are helpful in defining what is more likely to help a patient, it is not all the answer.
Even if critical thinking is an excellent tools to build “good maps” of the territory (or partial view of the reality) it is not the reality itself.

Thanks for your contribution here.

I couldn’t agree more!

‘Beauty is truth, truth beauty,—that is all
Ye know on earth, and all ye need to know.’

Thank you, amadis

Amadis

You’re making some sense, but are missing some key points. When you rightly point out that maps are just a model, that do not necessarily represent reality, you are thinking critically. When we advise tourists not to use a tube map to get about London on foot, we do so because we know that their chosen representation of reality isn’t suitable for the task in hand. Even an A-Z or Sat-Nav – like the RCT – has limitations, but again, to make this point we are thinking critically.

However, just because our methods have limitations in their abilities to represent reality – which exists separate to our whims, superstitions and hard won scientific findings – doesn’t mean that some aren’t (much) better than others in establishing functional, testable and reliable models. We shouldn’t feel bad about discussing the woeful shortfalls of the tube map with tourists, if we feel strongly that there are better models out there. Here’s a little treat:

“The first thing we can definitely say about reality from a human perspective is that we cannot experience reality directly. We have photons bombarding our retinas. We have vibrations in our inner ear, in our tympanums. The cilia of our nostrils and the buds upon our tongues transmit impressions of the chemicals comprising everything we smell or taste, while the minute electrical impulses racing through our nervous systems tell us whether we are touching silk or sandpaper. Moment by moment, we somehow compose these signals into a grand, shifting tapestry we call reality. It isn’t: It’s our sensory impressions of reality, with a direct experience of the thing itself being impossible. Effectively, to practical intents and purposes, reality is in our minds.” – Alan Moore

Sorry Amadis, that was a bit of a rushed post over breakfast. What I wanted to add is that skeptics try (not always successfully – it’s hard!) to apply critical thinking consistently – often at the expense of cherished beliefs. I think what you may be doing here is using critical thinking selectively in order to preserve a cherished belief (i.e. lurching from the critical points that maps, models and RCTs have limitations, to the uncritical point that this says anything about the truth of homeopathy, ying/yang etc.).

Not sure what you think?

Re: ‘We might disagree on where we draw the line on regulation, but to polarise the debate as libertarian democracy versus totalitarian paternalism (or whatever it is your ‘brigade’ stands for), in my view, isn’t helpful.’

Let me answer this:
1. Yes we do ‘disagree’ on regulation. I am utterly against an over-regulated society. Proposed anti-NHS homeopathy regulations stink as far as I am concerned – and thank Heavens three health ministers in a row have agreed with this. NHS homeopathic doctors certainly pose no more danger to the public than other doctors and many (including medical negligence in insurers, would say much less) Of course doctors must be accountable for their actions and doctors who are negligent in any way, face stringent discipline. That is all society needs to ‘protect’ itself from bad doctors. Remember homeopathic doctors don’t use homeopathy ‘instead of’ effective drugs, they use what they deem appropriate at any time.

2. Re: ‘to polarise the debate as libertarian democracy versus totalitarian paternalism (or whatever it is your ‘brigade’ stands for), in my view, isn’t helpful.’
No it’s not helpful to people who are unaware of the innate authoritarianism of the political actions they are espousing. The would presumably like to see themselves as liberal and democratic. The facts about these people are:
a) They would impose their views on others because they deem themselves to be more inteligent, well-informed, rational, less naive or whatever. That is authoritarian and illiberal. It is also condescending and patronising.
b) They care nothing for significant minorities of people: Whatever they say or do, a significant minority of people in the UK believe in and use homeopathy and CAM. Another significant minority of Britons, while not wanting homeopathy for themselves are quite happy for others to receive it on the NHS because they still believe in that most British of values – tolerance, as well as democracy of course. To seek to thwart the views of all these people apparently in the name of ‘science’ is authoritarian and illiberal as well as being an insult to science (knowledge) itself.

While there are doctors willing to treat these people responsibly, these doctors should remain on the NHS – as new Sec State for Healthy, Jeremy Hunt has correctly pointed out in the past – and THAT is the subject of this post.
c) They adopt a completely different attitude to unproven conventional medications and interventions than they do to CAM and homeopathy because imo they think that conventional medicines although UNPROVEN, are at least ‘rational’. This is nonsense. I say one litmus test of evidence for ALL options on the NHS. Is that unreasonable? You won’t see these people call for that though, even though I’ve pointed out over and over again that huge swathes of orthodox medicine do not have the requisite EBM being asked for by these people. It seems to be from this that Big Pharma must really love many of these people (Ben Goldacre excluded – okay? ) whether Big Pharma funds some of them or some of their institutions or not.

No I don’t polarise anything. This debate (on my blog) IS specifically about authoritarianism vs. libertarianism, using a very interesting medium: The public’s right to the sort of doctors they prefer.

I believe in their right to choose and on the NHS to which they contribute as taxpayers. So far 2 Government health ministers have agreed with me on libertarian grounds. Mr Hunt goes further. He not only agrees with my libertarian attitude to NHS homeopathy, he has openly praised the contribution of the NHS Homeopathic Hospitals to medicine and the NHS in this country and I thank him for that.

Dr Kaplan, you do polarise the debate because you mischaracterise what people like me tend to say.

I merely propose that the NHS does not pay for homeopathy because it is here that your libertarian argument breaks down. If people want to pay a private doctor, like you, to give them sugar pills, well, it is a free country and all that.

On the NHS though, such an action has consequences beyond the doctor and the patient. If the NHS were to be paying for noneffective treatments then, within a finite budget, then that may well deprive another person of an effective treatment.

At present, we hear of cataract operations being restricted to one eye per patient. If the NHS homeopathy budget could pay for a more humane level of treatment here then, in my opinion, that would be well worth it.

I do not see that in the slightest bit authoritarian – but as making ranked preferences in an area of limited resources.

And before you talk about convential medicine, such as SSRIs not being proven for some treatements, then yes, of course, I would hope the NHS was not wasting money there.

The issue is this though: if commissioning bodies cannot deal with homeopathy – an obvious quackery – then there is probably something much bigger being wrong. Homeopathy is a bell weather.

As for Hunt, I tweeted at the time that there are more worrying issues about him and that his support for homeopathy in a letter to a constituent is probably much more about his Tory dogma of choice over quality rather than any meaningful support of alternative medicine. My prediction is that he will do nothing to promote homeopathy – and will be quite happy to see CCGs cutting homeopathy as their budgets are stretched.

Andy,

I polarise nothing. The debate on my blog IS about liberty and democracy. I say significant minorities of taxpayers should have a say in whether they want homeopathy on the NHS or a Christian Democratic Party in power whether people like you think that Christianity is ‘unscientific’ and homeopathy is ‘quackery’ or not.

Re: I suppose you think your comments containing phrases such as ‘to give them sugar pills’ and ‘an obvious quackery’ are to be taken at face value.
Homeopaths do not think of themselves as thus when they sit down for an hour or more with a patient to listen carefully to everything they say so that they can match their symptom picture to a symptom picture a medicine chosen from many hundreds which they have spent thousands of hours studying. All this they do with passion, belief and compassion – for a modest living, most of them earning about 10-20% of what a modern medical consultant might expect to earn. To trash these utterly decent people because they believe in a different paradigm from your own – is pernicious in my opinion.

The reason you should start with what you describe as quackery in orthodox medicine is that the sums of money involved totally dwarf that spent on homeopathy. Most of psychiatric treatment has little evidence behind it (not only SSRIs). But no, you devote a website to attacking CAM but state in a comment here that you ‘hope’ the NHS wouldn’t be wasting money on SSRIs. Presumably you do this in the name of altruism towards those too stupid to know better themselves.

The most rational explanation for such incredible bias and a comically risible attitude to where taxpayers’ money is spent on the NHS, is quite simple: You care less about the NHS (and its financing) and patients’ health and choice than you do about attacking anyone whose philosophy of life is lightyears away from the cold, cynical, soulless, sneering, jeering, deterministic, mechanistic, authoritarian, anti-democratic paradigm of the universe which you inhabit.

L’enfer est plein de bonnes volontés et désirs

I make no assumptions about the intentions of homeopaths. Or about their desire to do good. It is irrelevant.

Quackery can exist without deliberate fraud or deception.

People can simply be wrong. Systematically.

But that is not the subject of your blog, so back to the question of choice, democracy and freedom.

Perhaps you can answer these questions which will shed some light on how you think about these issues?

1) Can you name any medical technique that is indeed quackery?
2) Should the NHS pay for it?
3) If yes, how do you justify the ethics of funding ineffective and/or deceptive treatment? Is this a good use ofpublic money?
If no, how should the NHS go about deterimining if a treatment is ineffective and/or deceptive.

My answers to your ‘When did you stop beating your wife?’ – style questions are limited by the nature of the questions and the lack of definition of terms. You may have your own defn. of ‘quack’ but to most it means ‘a deliberately fraudulent doctor’ of which I do not think there are too many examples. Homeopathy is no more ‘quackery’ or ‘deceptive’ or ‘ineffective’ than modern psychiatry in my opinion and much more cost effective to the NHS.

‘People can be wrong.’ Yes indeed. But who is to judge that? I personally think you are wrong. Very wrong. Both in your views on clinical medicine and in the politics of medicine. Although you are entitled to your opinion, even though I am not particularly partial to your bullying and derisory tone, the fact remains:

Two successive Governments and two Health ministers followed by a Secretary of State for Health totally agree with me on this issue.

Why don’t you just behave more like Socrates and take your hemlock like any self-respecting democrat? Perhaps because you are not a democrat. Hence my dubbing of you as ‘authoritarian’, ‘condescending’ and a supporter of a nanny state.

You did not answer my questions.

I would suggest you did not answer and claim it was a ‘beating your wife’ type question because you fully know you will get hooked on the problem that it is quite important to be able to demonstrate that treatments are effective before you publicly fund them. And that is a debate you refuse to have at all costs. You claim it is off topic. You resort to attacking your questioners.

Your libertarian stance can only survive superficial scrutiny. Your attitude to people like me testifies to that. Under no circumstance allow the limits of your position to be explored. Shut down debate. Call anyone who disagrees with you names.

Dr Kaplan

I have read your post and the comments below it with interest and increasing frustration. The questions Andy Lewis has put to you in his last comment are reasonable and on-topic and I perceive no “bullying tone” from him. On the contrary, it is your own continual misrepresentation of his viewpoint and your casting aspersions against the characters of those who disagree with you that has inhibited me from joining in here and I only do so now because I really want to know your answers to Andy Lewis’ questions.

I’m sorry but your attempt to avoid answering these questions leave you looking caught like a rat in a trap.

I did not answer your questions because they use terms such as ‘ineffective and/or deceptive treatment’ and ‘quackery’. It would take time for us to agree on terms and there is little point in it.

I disagree with your whole premise that homeopathy is deceptive or quackery or ineffective or does not work. It clearly DOES work as shown by outcome study after outcome study and I don’t care what you think about outcome studies; I value them. HOW it works is another matter altogether and worthy of discussion. Even if you think this is due to long, empathic consultations and the belief of the homeopath, this is no valid reason for your hostility to it while you seem happy not to protest at the way Big Pharma fleeces the public in so many ways.

‘Shut down debate’ ? I’ve challenged you to a live debate several times so that we can see what others think of our positions. Successive health ministers and a health secretary agree with me but a neutral audience would shed some light on this. However you risibly said that I was not a worthy opponent in such a debate. Apparently I both ‘shut down debate’ and I am not worthy of a live debate on this subject in spite of 3 decades of medical experience and 25 years of using homeopathy. Clearly only people with your qualifications (which we are still waiting for on this site – Talk about me not answering questions!) and character and logical thinking capacity And as for name calling. Do you want me to list the pejorative terms you have used to describe me and my practice of medicine in the comments section here (all of which I have publishedI)?

So someone who has challenged you to a live debate is actually the same person who ‘shuts down debate’, hey Andy?
You feel free to pejoratively describe me but when I use words like authoritarian, mechanistic, nanny state, deterministic to describe you, you accuse me of calling you names.

I guess you never did look up ‘projection’ in a dictionary of psychology, did you?

Ah Jem! You clearly enter the discussion as a ‘neutral’ don’t you? :-)

I have little interest in what I look like to you though. There are plenty of others who are not ‘frustrated’ by what I say here. Also successive health ministers tend to agree with me so far.

I’ve given reasons to Andy (below) as to why I am not going to answer his loaded ‘When did you stop beating your wife?’ style questions, full of terms that I do NOT agree apply to homeopathy. Andy has been challenged more than once to meet me in live debate in front of an audience or on radio. Although he continues to post comments here, he has declined the challenge on the basis that I’m not a ‘serious player in this discussion’. I would use a common poultry term to describe his real reasons.

I hope that makes things a little clearer for you.

Dr Kaplan,

You have still not answered the questions.

It was crystal clear in the first place. Even more so now, thanks.

So, let me help you out.

My questions again,

1) Can you name any medical technique that is indeed quackery?
2) Should the NHS pay for it?
3) If yes, how do you justify the ethics of funding ineffective and/or deceptive treatment? Is this a good use ofpublic money?
If no, how should the NHS go about deterimining if a treatment is ineffective and/or deceptive.

Please note, that these are open questions that do not apply to homeopathy. You are free to pick on any therapeutic approach you choose.

You are free to interpret words like ‘ineffective’ or ‘deceptive’ in any way you like, but best to be clear about how you use the terms. I do not think these are hard words subject to ambiguity. For me, I simply see them as being applicable to claims made for a therapy that are not true.

One final question: if you cannot engage in simple questions like these on your own blog on the topic that you have chosen to defend your stance, what makes you think I would want to debate you in front of a live audience? PS My answer has a farmyard description too – nothing to do with poultry but more to do with waste from the male of dairy animals.

Seeing as the issue of being an expert in randomised controlled trials has come up I figure I could offer something useful by making everyone an expert in RCTs.

There are all manner of effects and interpretations that people apply to their experiences of healthcare. They may think they are getting better when given a placebo simply because they confuse correlation with causation. That is to say they are given a placebo, their condition improves on its own, and they incorrectly believe the placebo is responsible.

Thus RCTs place the patient into one of at least two groups and blind the patient as to whether they are receiving treatment/placebo (or more commonly in medical research new treatment versus best old treatment).

This way the effects of mistaking correlation for causation are mitigated as the placebo response can be compared to the treatment response statistically to see whether one has a bigger effect than the other.

In the highest quality RCTs double blinding is used because if the researcher knows that they are giving the patient the new treatment they can do all sorts of subtle concious and unconscious things to bias the patients response. Double blinding means that no one involved in administering the placebo/treatment to either group is aware which they are dispensing.

Now when this method is applied to homeopathy it turns out homeopathy doesn’t fare any better than placebo at treating anything. Which is perhaps why Homeopathy has tended to favour provings instead as these involve no blinding and are, in reality, no different from anecdotes.

Some Homeopaths do believe that because homeopathy is an individualised medicine that it cannot be tested by RCT. However there is no logical or rational reason to assume this should be the case.

However I offer a challenge to any Homeopaths reading who might want to prove that their individualised remedies work. After a consultation with a customer you allow a researcher to randomly administer a placebo treatment or the homeopathic preparation you have prescribed to them. They will not have contact with the patient and it can be arranged in such a way that they cannot have contact with the homeopath. Then without knowledge of whether a placebo or treatment has been given we observe and record the effects of both on the customer and see which fares better.

Any Homeopaths up for that? Or is the thought that you might discover that any “healing” effects caused by your practice are solely down to your own relationship with the patient and the psychosocial aspects of the consultation rather than the magic water in which you put so much stock to much to bear?

I have given you the reason I will not answer your “When did you stop beating your wife?” – style questions containing terms that require definition before even being discussed.
You however, have failed to answer a very straightforward question from another commentator (and supported by me) about your qualifications to be a commentator on health and health politics.

I am puzzled that you would spend so much time commenting on my blogs but fear meeting me in public debate which would have many advantages over this sort of ‘argument’.
Okay some brief answers, curtailed by the nature of the questions and lack of defn of terms.

1. Cannot answer because my defn. of ‘quackery’ is very different from yours. Many interventions in psychiatry do not have much evidence to back them up but I would not call psychiatry (or homeopathy) quackery.

2. Yes, the NHS should pay for doctors, GPs and psychiatrists who prescribe psychotropic drugs (eg SSRIs sans much evidence in moderate and mild depression) and homeopathy. This is because the psychiatric medication, the consultation, the belief of the doctor in the combination of his consultation and the medicine, are all assessed by the doctor as being beneficial for the patient and outcomes are assessed as being positive – whatever the exact reason for this. Psychiatrist would be accountable of course. Same applies exactly to homeopathic doctors. ie Doctors should make these calls, not people high in opinion but low in medical qualifications and sans clinical experience.

3. This one I can answer quite simply: I favour trusting doctors and disciplining them only if they are negligent. However if we elect to move into a more authoritarian era in medicine (and everything else) – and I oppose this as you well know – then the NHS would have to establish and publish a LEVEL OF EVIDENCE which any intervention would have to pass, to be included. ie a level playing field for ALL proposed interventions. This would be strongly opposed by Big Pharma because as the BMJ’s Clinical Evidence and my PIe Man clearly point out, the evidence isn’t that great for MANY ‘conventional’ interventions. SSRI’s for moderate and mild depression would struggle to qualify for any reasonable evidence based (exclusively RCT style investigation) and their budget is about 20x that of NHS homeopathy! And that is why you won’t find Big Pharma – as much as they detest the competition of CAM – lobbying for a level playing field of qualification for all medical interventions to be allowed on the NHS

    Instead there is this nasty and relentless campaign of jeering and sneering at CAM exclusively while the odd commentator also lobs a criticism at Big Pharma here and there. No hypocrisy in that is there Andy?

    You can say what you like about me but it is I who am prepared to meet you in live debate and you who thinks it a waste of time, while apparently having a lot of time to comment here.

Hi Keir,
This is reasonable except for ‘Now when this method is applied to homeopathy it turns out homeopathy doesn’t fare any better than placebo at treating anything. Which is perhaps why Homeopathy has tended to favour provings instead as these involve no blinding and are, in reality, no different from anecdotes.’ By this you show you do not understand what a homeopathic proving is. It is certainly not to be compared or contrasted with a clinical trial.
But yes we do know this stuff and there have been many clinical trials and meta-ananalyses of those trials. The overall impression of homeopaths is that they show that homeopathy works and the impression of critics is the opposite. There is an ethical issue with your very reasonable way of testing whole person homeopathy and that is homeoapaths cannot subject their individual patients to that. It needs to be done in a major NHS hospital. Eg Bristol H H where 6 year outcome studies showed brilliant results. However the critics do not wish this to happen and say it’s a waste of money. This in spite of the incredibly good outcome study results.

Sorry Dr Kaplan, it’s not my intention to catch you out, but it is to understand you properly. In a previous blog (I’d have to dig it out) you referred to the continued rise in anti-depressant prescribing since Kirsch et al’s landmark meta-analysis as an ‘outrage’? But if I understand you right here, you feel the NHS should continue to fund this ‘outrageous’ practice? That sounds sort of strange…

I notice once again you decline to really answer the questions despite me giving you as much leeway as you like in answering them.

So, maybe we can try to move on.A couple more questions.

1) How would you define quackery?
2) If you believe things like SSRIs have no specific effects for low to moderate depression, are you saying that all the doctor does is offer placebo effects?
3) Is this also true for homeopathy, and if not, how do you know?

Sure adzcliff,

In spite of Kirsch et al’s very clear message, the prescriptions of anti-depressants sky rocketed. What was outrageous is that this was hardly news and hardly worthy of the attention of the ‘skeptics’ who show their apparent altruism for the people of the UK by focusing on being anti-CAM exclusively, even though the bill for these drugs dwarfs that of the NHS bill for homeopathy by 20/1.
Nevertheless doctors should be ‘allowed’ to prescribe these drugs in spite of Kirsch et al. There are certain patients who might respond to the combo of consultation, the chemical effect of the drug, the confidence of the doctor in the drug etc. Doctors should be MADE AWARE of Kirsch et al but not THWARTED from prescribing SSRIs on the NHS. The same should go for homeopathy and so far it has – but not if Andy Lewis et al had their way.

Okay Andy,

1. Quackery: Deliberate misrepresentation of the positive clinical effects of a substance, a device, or a person to prevent or treat disease. (Note the word ‘deliberate’ )
2. It is Kirsch et al who have demonstrated that they are not better than placebo in these situations – not to mention SEs either. Imo it is up to the doctor to prescribe them after being
informed by Kirsch of course. In some individual cases they may work quite well. Once again a demonstration of how a Gaussian curve needs to be looked at a little differently in medical and biological models and you do need a medical education and clinical experience to understand this.
3.I know that homeopathy is not placebo from personal experience: Many years ago I did some tests in my practice by prescribing a series of numbered powders and putting the active
homeopathic ingredient in say powder 20 of 30. This way I saw which patients responded to placebo and which to the active ingredient. This will not mean much to you but it certainly
convinced me. However, as I’ve said before, it doesn’t matter HOW patients get better on homeopathy, only that they do get better.

This concludes discussion tangential to the subject of the post, the appointment of Jeremy Hunt as Sec State for Health and his previous supportive remarks about NHS homeopathy.

Thanks Dr Kaplan

I agree psychiatric prescribers should be made aware of Kirsch et al. and related studies, but I’m willing to bet many (most even) have either never heard of them; recall the discussion, but have limited/no understanding; or have forgotten about it. I think this might be an example doctors not necessarily being the scientists we hope they are.

“It is Kirsch et al who have demonstrated that they are not better than placebo in these situations – not to mention SEs either.”

Just to respectfully clarify on this (as I understand it): when Kirsch unearthed around 40% of the entire clinical evidence-base for SSRI’s hidden in drug company drawers, the efficacy of anti-depressants (ADs) plummeted. However, they still showed a ‘statistically’ significant effect over placebo, although not reaching the arbitrary benchmark for ‘clinical’ significance. He and others also questioned whether it’s ever possible to conduct double-blind RCTs on psychoactive substances, given that one group will experience side-effects that assumingly the other wouldn’t. Participants who experience subjective changes in body and/or mind (or whose clinicians detect changes), in effect might ‘break blind’, and experience of feelings of hope, expectation, indifference, whatever, on detecting they’re probably in the ‘treatment group’. Kirsch and others therefore hypothesised that AD treatment may be in the side-effects (i.e. an ‘active placebo’). This idea is given greater plausibility by Moncrieff et al’s earlier work trialing Atropine against placebo for depression (i.e. a cardiac drug that’s never been labelled an AD but has a similar side-effect profile), which, interestingly, showed a very similar effect to ADs. Needless to say critics continue to debate the minutiae of statistical significance, and/or whether Atropine has, in fact, undiscovered AD qualities – as well as interesting denial amongst true believers in the (flawed) biological model of depression, that clinical studies should never trump clinical experience and what is ‘known’ by doctors, …oh, and questioning Kirsch’s credentials as an clinical/academic psychologist, who’s never prescribed a psychiatric drug in his life.

Not sure if that’s interesting or not…

…and whether Kirsch, Moncrieff and colleagues should give psychiatry and the pharmaceutical industry a break, and, in the name of balance and fairness, say something critical about CAM for once, I’m not sure. I think it’s entirely acceptable to have a special interest, and focus entirely on that if one wishes.

Much of interest in your previous remark, but here I disagree. To be biased against CAM on the NHS but not unproven conventional medicines is deeply disingenuous in my opinion and also happens to suit Big Pharma very well indeed.

Quite Adzcliff. Just what are Kirsch’s credentials that allow him to criticise the clinical experience of all those doctors?

Your problem with me Dr Kaplan is that you can never accept the premise of my chosen topic for my website: that superstitious medical beliefs persist and thrive. Why a form of sympathetic magic, such as homeopathy, can survive in modern medical practice, is, on the face if it, astonishing. For me understaning that is crucial in understanding wider problems, not just in healthcare, but in broader society.

Jeremy Hunt is just one more fascinating subject in this area. Although, in this case, I think his position is easily explained. Tory policy to undermine public services has consistently used the right wing sacred cow of ‘choice’ to break up existing power structures. I would bet that Hunt has not real clue about homeopathy, but is very keen to ensure that the power of existing medical bodies is undermined at any opportunity. Evidence based medicine is a power that stands in the way of unfettered access by his business buddies. His support for homeopathy is not there to support homeopaths, but to support Richard Branson and the pharma paymasters of the Tory party.

Just watch homeopathy continue to slide out of the NHS. The Tories have no real interest in it beyond any potential to disrupt existing state power.

I would also like to add that your definition of quackery is exactly the opposite conclusion I have come to: that deliberate misrepresentation is actually relatively rare. Quackery cannot be understood as a form of fraud: it is a manifestation of pathological belief systems and basic delusions akin to religious or superstitious belief.

I would like to thank you Andy for an authentic and erudite expression of your position on this. In terms of a reply I would say that the key words I must address are: ‘you can never accept the premise of my chosen topic for my website’ Yes indeed Andy. That is exactly why I refrain from commenting on your website.

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