//Homeopathy, Clinical Outcome and People

Homeopathy, Clinical Outcome and People

In a recent interview, I drew attention to aspects in the ongoing debate about homeopathy, that I feel have been somewhat under-discussed.

The first is that our critics never seem to mention the patient and empathic way homeopaths listen to the story of their patients’  illnesses in the context of their whole lives, before even thinking of which ‘controversial’ white pill to prescribe. Critics and sceptics may believe that homeopathic benefits (‘if any’) derive solely from this. If this is what they believe, they should say so openly. If they are genuinely interested in patients’ well being, the next logical step would be a major medical investigation into trying to understand why patients who are listened to in homeopathic, way start dramatically improving!

The second aspect I believe does not get enough attention is Outcome and Patient Satisfaction. An outcome study is a study in which patients are simply questioned comprehensively on the outcome of any medical intervention. In this regard, homeopathy has scored very highly as in the Spence  Outcome Study in Bristol. That study was attacked by critics – mainly due to their distaste for outcome studies in general.

But why? For patients outcome is everything. Patients care about getting better; how they got better is of secondary importance. What critics of homeopathy have done is to some extent deride the obvious beneficiaries of homeopathic treatment.

Just as homeopaths listen to suffering patients carefully and empathically, so critics of homeopathy should listen to what satisfied homeopathic patients have to say about their experiences. Outcome studies are no more than a collation of the voices of patients – the very people whose welfare this debate has  apparently been all about.

By | 2014-08-22T09:23:59+00:00 August 22nd, 2014|Homeopathy|3 Comments

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  1. Adzcliff August 22, 2014 at 3:00 pm - Reply

    Hi Dr Kaplan

    It’s been a while, but I was interested in this point:

    “The first is that our critics never seem to mention the patient and empathic way homeopaths listen to the story of their patients’ illnesses […]. If this is what they believe, they should say so openly. If they are genuinely interested in patients’ well being, the next logical step would be a major medical investigation into trying to understand why patients who are listened to in homeopathic, way start dramatically improving!”

    Well my understanding is that they do mention the empathic nature of the homeopathic consultation, and do so repeatedly and openly. In example, you might want to want this watch this Youtube clip of Prof. Richard Dawkins and Prof. Michael Baum (at approx 6mins and 11:30mins). What you’ll find is a deep respect for the homeopathic consultation, and the belief that mainstream medicine could benefit from some of this:


    Ben Goldacre too cites evidence that doctors who adopt a warm, friendly and reassuring manner are more effective than those who keep consultations short and formal. He also rues the limitations of the 6 minute GP consultation to maximise the therapeutic relationship (Bad Science, p75-76).

    Prof. Edzard Ernst also says this in support of the homeopathic consultation:

    “If observational data show improvements while clinical trials tell us that homeopathic remedies are placebos, the conclusion that fits all of these facts comfortably is straightforward: patients get better, not because of the homeopathic remedy but because of a placebo-effect and the lengthy consultation with a compassionate clinician.” (Guardian 2012)

    He also cited Brien et al. (2011) to back this up, that concluded:

    “Homeopathic consultations but not homeopathic remedies are associated with clinically relevant benefits for patients with active but relatively stable [rheumatoid arthritis].”

    You’ve perhaps also read Kliems & Witt (2011) who conclude:

    “The findings confirm other studies of patient satisfaction and physician characteristics. The availability of time, a holistic approach, and high physician empathy lead to high patient satisfaction. Homeopathic physicians probably are more likely to exhibit these characteristics.”

    Makes me wonder why you’d say that, as I’m assuming you are more knowledgeable about the views of your critics than me?

    Sorry for going on a bit, and thanks for your time.

  2. liana August 25, 2014 at 10:34 am - Reply

    Thank you Dr. K for such a clear and helpful explanation. Your reassuring voice reminds me of the old-fashioned doctors when you felt they really cared…

  3. Bill LaChenal (London) August 26, 2014 at 12:18 am - Reply

    Hi, Brian

    I’m really in two minds about this. My own short answer is, “it depends”.

    It depends very much on how exactly an outcome study is conducted, and there seems to be no clear standard, and precious little common sense in how these things are done.

    Have you ever given in to one of those polite, insistent requests to fill in a survey about your experience with a website or service? Most will find them a terrible waste of two minutes of your precious lifetime, followed by another couple of minutes wasted immersed deep in regret and self-loathing at your weakness of judgement in imagining they might actually be relevant to anything at all.

    There seems to be a whole industry engaged in collecting answers to fatuous questions, whilst purposely excluding any opportunity to gather potentially useful input. They probably have a Guild.

    Famously, people have given wonderful recommendations for some of the worst dentists ever known to the history of the NHS, whilst others have been deeply dissatisfied with some of the best.

    That sort of data collection (as often practised by health authorities)is just frustratingly unhelpful, so I can have a very slight sympathy with the skeptic crowd in their suspicion of such things. Very slight.

    Where I have very little to no sympathy, is where homeopaths (and some very well known ones at that) refuse point-blank to collect outcome data. I’ve heard all sorts of excuses when I’ve prompted people. I just find it unacceptable and damaging to the reputation of all good homeopaths for people to carry on this way, imagining that actually monitoring their results is a dispensable overhead.

    And I am frustrated by alt-med people with little or no understanding of the concept of scientific proof (genuine proof, not the distortions of the so-called skeptics, who never seem able to be skeptical about anything pharmaceutical).

    On the other hand, when it comes to so-called ‘gold standard’ variously blinded RCTs, the pharmaceutical corporations (and the droves of statisticians & operational researchers) have really pulled a fast one on the ‘conventional’ world by confusing & conflating good clinical outcomes with theoretical indications of what might be a good profit yield.

    Some very few will have done this deliberately, simply in order to build false cases against their competition – most will just have gone along with the delusion out of lazy thinking.

    The whole construct is an intellectually-appealing confidence trick.

    Pharma is in the Procrustian business of one-fits-all solutions. Individualised cures are an embarrassment to the balance sheet, and have to be explained away (or simply discarded as anomalous, spontaneous remissions, “isn’t the human body wonderful?”). Individuals damaged ‘in the field’ are a different embarrassment to be somehow magicked away for long enough to gather a few more millions (billions) before the insurance claims come in, the whistle-blowers pop up, and the cover-ups are exposed.

    Of course, Pharma acting badly does not prove that homeopathy is good, but it does go some way to explaining cult of attacking what does not bring profit to the controlling corporations. These skeptics really do believe they are right; it’s how they have been brought up to depend on authority rather than actual practice. Fundamentalists. Poor deluded souls. If they had souls.

    What would be immensely helpful would be to develop rather better methods for measuring outcomes for individuals – as you have said, this what really matters to a patient – and build a big enough body of experience for these methods for them to be seen as reliable.

    Small-sample methods such as ranking tests would very likely turn up more interesting results than the currently favoured frequentist approach, and be applicable to the smaller size tests generally available to less well-funded alt-med investigations.

    Multi-variate analyses would suit homeopathy and other holistic approaches – would suit humans – much better than the single-issue almost Newtonian determinative view endemic in pharma medicine.
    It will happen, eventually, even for more advanced pharmaceutical approaches.

    They will have to go that way, but of course they will hope to eliminate the competition first.

    For homeopaths to go on being simply trusting, and not doing the modern investigations, is not an alternative. Going along with inherently faulty mathematical methods intrinsically biased against holistic medicine, that’s not an alternative either.

    One of the great strengths of homeopathy ought to be its totality of good clinical outcomes. If only that were properly recorded, beyond suspicion of mere anecdote. I suspect it would compare very well with what has become de facto ‘conventional’ medicine, and would win hands down on cost-effectiveness.

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