//NHS HOMEOPATHY: The Aftermath and the Whingeing

NHS HOMEOPATHY: The Aftermath and the Whingeing

After the Government decided to back NHS homeopathy on 26 July, the whingeing of homeopathy’s detractors has been something to behold. Although I sincerely congratulated the Government on striking a blow for democracy and liberty in making this decision, I can understand how aghast and horrified those I’ve dubbed the Disciples of Scientism are now feeling. It is inexplicable, outrageous and irrational to them that their powerful attempt to thwart (rather than dissuade) NHS GPs from being able to refer patients to NHS homeopathic doctors at NHS homeopathic hospitals, was ultimately unsuccessful. In the end democracy trumped scientism. Perhaps those with a scientistic orientation took Winston Churchill too seriously when he said: “The best argument against democracy is a five minute conversation with the average voter.” My view is that even if that were true, democracy is still the best political system available. And in this democracy it was clear to everybody that the two main parties in the adversarial system were both against banning NHS homeopathy. Mike O’Brien, the ex-Labour Minister of health said it would be ‘illiberal’ to cut funding NHS homeopathy and Coalition Minister of Health, Anne Milton, booted the anti-democratic recommendations of The Science and Technology Committee into touch.

Homeopathy’s detractors have no inclination to accept either the will of the people or the decisions of this Government or the last. They clearly know they are right and do not wish to be confused by facts, democracy or DoH decisions. Although temporarily bloodied, they will surely re-group and attack again; they cannot help but do this. As Prof. Edzard Ernst, a major player in the failed campaign to delegitimise NHS homeopathy whined on the Pulse website: “In the final analysis, it is also about the patient who got an unfair deal which will deprive many of effective therapies.” What about all those patients who benefited hugely from NHS homeopathy whatever Ernst thinks was the reason for their recovery?

Another disappointed critic, Prof. Michael Baum, moans in the current edition of The Lancet of the decision of the DoH to back patient choice: “Using this kind of logic, why not offer astrology on the NHS to help women decide when to induce labour?” Do GPs want to send pregnant women to astrologers? No. Do they want to refer them to homeopathic doctors. Yes a significant number do, otherwise the homeopathic hospitals could not exist. No need to mention the fact that the homeopathic hospitals were invited to be part of the NHS at its inception in 1948. No need to mention the many outcome trials that show that patients visiting homeopathic hospitals express a high degree of satisfaction – and these are patients that were not generally helped by conventional medicine.

I am grateful to the Government for upholding liberty and democracy in this country and to all those who fought long and hard (against the odds – given our resources and media exposure compared to our opponents’) to win this battle. However the time has come for me to focus again on clinical issues – in particular my passion for a whole person medicine approach in medicine in general and in particular on Provocative Therapy, the cutting edge in the use of reverse psychology and humorous insights in psychotherapy.

In my next post: Why Provocative Therapy is very different from Laughter Therapy or ‘Laughter Yoga’

By | 2010-08-27T18:43:36+01:00 August 27th, 2010|Homeopathy|58 Comments

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58 Comments

  1. Andy Lewis August 27, 2010 at 9:53 pm

    Dear Dr Kaplan,

    Could you point me to the bits in the government response where they “decided to back NHS homeopathy”?

    I must have missed that section. My reading was that they were choosing to do nothing and delegate all responsibilities to PCTs. And the PCTs are choosing to stop funding.

    Happy to be proved wrong though.

    Over to you.

    Andy

    • Dr. Kaplan August 28, 2010 at 9:54 pm

      @Andy Lewis
      Of course the Government did not use those exact words. However the Science and Technology Committee made some radical recommendations about cutting the funding of NHS homeopathy totally and how homeopathic medicines should be labelled, shelved and sold. All these recommendations were comprehensively rejected by the Government and would have been rejected by the last Government if you read what Mike O’Brien said when addressing the committee. Thus the Government ‘backed’ the status quo of NHS homeopathy. It’s true that they left the the responsibility to local NHS PCTs (where it has been for some time) and doctors but it’s also true that they have spoken about phasing out PCTs which would leave the responsibility of whether or not a patient will be referred to an NHS homeopathic hospital with doctors – which is exactly where I’ve always thought it should be. I am totally against non-medically qualified bureaucrats controlling doctors’ decisions particularly by diktat from Westminster but also from local PCTs. In the end our disagreement on this issue is simple: I think the campaign against NHS homeopathy should have been directed towards doctors – not those who seek to control the lives of doctors. If you could persuade doctors not to make homeopathic referrals then that would signal the end of NHS homeopathy. I would not have agreed with such a campaign but I would never have described it as disingenuous. Otherwise why not start a campaign for ‘ONLY EBM ACROSS THE BOARD ON THE NHS!’ But to use EBM as a blunt instrument to attack homeopathy exclusively always seemed very illiberal and undemocratic to me.

  2. Rob August 27, 2010 at 10:27 pm

    The government did not “back NHS homeopathy”, but kept the decision on whether to fund it with Primary Care Trusts. How’s that endorsement been working out recently?

    “Doctors in Greater Manchester have been advised not to prescribe homeopathy by the region’s NHS medicine decision-making body.”
    http://www.bbc.co.uk/news/uk-england-manchester-11022795

    “NHS Oxfordshire, said: “Patients would not normally be offered complementary or alternative therapies in specialist, secondary or primary care settings, due to a lack of conclusive evidence as to effectiveness and limited resources.” ”
    http://www.banburycake.co.uk/news/8304779.County_rules_out_NHS_funding_for_homeopathy/

    • Dr. Kaplan August 28, 2010 at 10:00 pm

      @ Rob I think my reply to Andy Lewis applies to your comment too. I really do think we should trust doctors to make informed and accountable decisions about patients. As I’ve said many times: I don’t approve of non-medically qualified bureaucrats controlling the clinical decisions made by doctors. And the money argument is complete nonsense – as I’ve shown in a previous post.

  3. Stefan Chmelik August 27, 2010 at 10:54 pm

    Well out. And lets be clear that scientism has little or nothing to do with science, but rather is the domain of the flat-earth thinker.

    • Dr. Kaplan August 28, 2010 at 10:18 pm

      @ Stefan Chmelik The whole concept of scientism is very interesting. ‘Scientismists’ see no need to study philosophy or philosophy of science. They think that is all complete nonsense and that they are right – end of story. They are also tend to be offended when other people don’t accept what to them is obvious and deeply offended when their views are trumped by the democratic process – which is what happened here. Prof. Michael Baum’s letter to The Lancet (current edition) is a case in point. He ends the letter with the comment: ‘Shame on you, Health Minister’. The fact that democracy trumped scientism here is unbelievably offensive for those people who are absolutely certain that they are right about homeopathy.

      I don’t know about scientism and flat-earthism unless you mean that science is always going to be out of date when looked at retrospectively. Just for the record here is Wikipedia’s explanation of the neologue – scientism.

      Scientism is the idea that natural science is the most authoritative worldview or aspect of human education, and that it is superior to all other interpretations of life.[1] The term is used by social scientists such as Friedrich Hayek,[2] or philosophers of science such as Karl Popper, to describe what they see as the underlying attitudes and beliefs common to many scientists, whereby the study and methods of natural science have risen to the level of ideology.[3] The classic statement of scientism is from the physicist Ernest Rutherford: “there is physics and there is stamp-collecting.”[4]

      The term is used in either of two equally pejorative directions:[5][6]

      To indicate the improper usage of science or scientific claims[7] in contexts where science might not apply,[8] such as when the topic is perceived to be beyond the scope of scientific inquiry; or there is insufficient empirical evidence to justify scientific conclusions. In this case it is a counter-argument to appeals to scientific authority.
      To refer to “the belief that the methods of natural science, or the categories and things recognized in natural science, form the only proper elements in any philosophical or other inquiry,”[6] with a concomitant “elimination of the psychological dimensions of experience.”[9][10] It thus expresses a position critical of (at least the more extreme expressions of) positivism.[11][12]

      and there is more in Wikipedia on this concept.

  4. Dr Andrew Sikorski August 28, 2010 at 10:20 am

    Scientism should view Provocative Therapy with great delight as it proposes a unified view the whole universe must run solely on scientific principles which are ultimately the sole message to be deciphered in all religious texts and the ultimate answer to what occured in the nanoseconds, seconds, minutes, hours, days, weeks, months, years, decades, centuries, yet alone millenia preceding ‘The Big Bang’.

    • Dr. Kaplan August 28, 2010 at 10:03 pm

      @ Dr Andrew Sikorski
      Reader of these comments are advised to study the principles of Provocative Therapy in some detail in order to understand your comment 😉

  5. Rob August 28, 2010 at 11:36 pm

    @Dr. Kaplan
    “leave the responsibility of whether or not a patient will be referred to an NHS homeopathic hospital with doctors – which is exactly where I’ve always thought it should be.”

    Which is a fair position. If only there was some way of knowing what doctors think of homeopathy…
    http://www.telegraph.co.uk/health/alternativemedicine/7728281/Homeopathy-is-witchcraft-say-doctors.html

    • Dr. Kaplan August 29, 2010 at 5:46 pm

      @ Rob: I get your point, but my point is that a significant minority view needs to be respected. As I’ve said many times, if doctors don’t refer patients to homeopathic hospitals, those hospitals will necessarily have to close. What I oppose is the authoritarian attempt to thwart (rather than dissuade – which I would never object to) doctors (ie NHS GPs) from making these referrals as the Commitee of S&T recommended. I’m not that happy with the present situation where GPs can be thwarted in the clinic by PCTs comprising mainly non-medically qualified people, but that has been the status quo for some time. Hopefully they will be phased out sooner rather than later and the responsibility for what medical care patients get be left with those who know the patients concerned the best – their doctors. Surely that’s reasonable. If not, why not?

  6. paul August 29, 2010 at 9:18 am

    Hello Briann,

    I thought I would post a link to an article which supports the argument that EBM isn’t all that it seems. I wonder when those fellows from the school of scientism will begin to see how hypocricical their arguments are?

    http://www.eurekalert.org/pub_releases/2010-08/asa-pam081010.php

    Regards

    • Dr. Kaplan August 29, 2010 at 5:54 pm

      Hi Paul,
      Thanks for that. Re: “I wonder when…” It isn’t going to happen. These people don’t see themselves as being scientistic at all; they see themselves as rational human beings who simply cannot understand how people may not agree with their point of view and would happily foist their views on the people. Politically the NHS is funded by national insurance which everyone pays – so I think it’s reasonable to listen to significant minorities of doctors and patients.

  7. Andy Lewis August 29, 2010 at 2:54 pm

    So, Dr Kaplan. The Government did not use ‘those exact words’. In fact, the government did not ‘back homeopathy’. It quite clearly stated that it “agree[d] with many of the Committee’s conclusions and recommendations.” However, it chose to preserve the status quo by delegating responsibility down the NHS chain. And that chain is abandoning homeopathy pretty quickly. That hardly strikes me as a victory for homeopaths. Whilst not a swift mercy kill, I believe the Evidence Check report will remain a very powerful document when any group of GPs/PCTs decide to review their position.

    As for the second thrust of your post – that homeopathy’s critics are guilty of ‘scientism’, can you explain in detail
    where science is being misused in the report or elsewhere in its critique of homeopathy?

    • Dr. Kaplan August 29, 2010 at 5:39 pm

      @Andy Lewis: Let us be clear: The Government did not adopt any of the draconian and radical recommendations of the Committee. This is why homeopathy’s opponents are livid (see Michael Baum’ letter in The Lancet). NHS Homeopathy won this particular battle but not without cost – as you have pointed out. Damage to the public perception of what homeopathy is all about was achieved by the media campaign that gave homeopathy’s opponents MUCH more space and time than its supporters. Nevertheless the Government chose NOT to go with a bullying populist view and chose instead to respect a significant minority viewpoint.

      On scientism and science being mis-used here: We have been through this before. Difficult-to-treat patients benefit from visiting homeopathic NHS hospitals as shown by outcome studies. I can understand the view of the sceptics being that it is placebo, good bedside manner etc that achieves this – even though I don’t agree. It is scientistic imo to want to shut the hospitals down. A scientific and humane view would have been to do some different sort of trials. eg
      1. Do long term studies of patients attending homeopathic hospitals to see if their improvement is maintained.
      2. Do a study comparing patients being referred to doctors specialising in psychosomatic medicine and those referred for homeopathy.

      Do read the Wikipedia entrance for ‘scientism’. The essence of my argument here is political as it has always been. I favour listening to the people not imposing science, religion or anything else on them. For example, there is hardly a scientific reason to keep the Royal Family (v. expensive) but the people want them so that is good enough for me.

      I strongly oppose societies with authoritarian leaders who impose their views on the people, be those views be based on religion or science. Spain in the Inquisition was an example of the former and a very good example of the latter was the Soviet Union.

  8. Andy Lewis August 30, 2010 at 12:09 pm

    I am not sure you have answered my question of stating where in the MPs report science was misused. It is not ‘scienticism’ to come to the conclusion that because of the basic implausibility and lack of good evidence for homeopathy that it should not be funded. The ‘choice’ argument was explicitly tackled in the report by highlighting the associated ethical dilemmas.

    You appear to believe that it is wrong to use such scientific arguments to decide what treatments should be publicly funded. I am not sure you really believe that. Could you state what criteria you would use? Would you allow any treatment to be ‘chosen’ on whatever grounds, without regard to costs, evidence or direct and indirect harms? Is demand enough for you, free from allauthorities to say ‘no’?

    What ‘authorities’ would you use in such decisions? Would you allow endangered animal parts? Muti killings? What about spa weekends in mountain retreats for people with minor complaints? People hold sincere beliefs about such things and I am sure you proposed outcome studies would look favourable too.

    • Dr. Kaplan August 30, 2010 at 12:45 pm

      @Andy Lewis If we did not have a universal healthcare system in the UK (and I strongly support the NHS), then people could choose which doctors they wanted to see. With universal healthcare funded by direct taxation, we do need to listen to the will of the people and not bully significant minorities such as those that want homeopathic treatment. Wrt to your comment about endangered animal parts and muti killings – I don’t think you will find significant minority support for these although the case for ‘spa weekends in mountain retreats’ is a moot point. Andy, you seem to be fond of pointing out how I don’t answer your many questions. How about you answering some of mine?

      1. Why do you think that GPs should be thwarted (rather than dissuaded) by non-medically qualified bureaucrats from making referrals to homeopathic hospitals?

      2. What justification is there for using EBM as a blunt instrument to attack homeopathy exclusively? Surely an honest scientist (and even an honest scientismist) would call for one standard of EBM to be applied across the board in the NHS? Depending on the level of evidence required, many conventional medicines would fail to make the cut – eg SSRI anti-depressants whose NHS budget dwarfs that of homeopathic medicines by a ratio of 20 to 1. Do you not see any application of double standards here?

      3. Would you accept that homeopathy has a special status in the NHS because the homeopathic hospitals were invited to become part of the NHS at its inception in 1948 – particularly bearing in mind that the arguments/insults/denigration of homeopathy was much the same then as it is today? Medicine based on ‘muti killings’ and ‘endangered animal parts’ did not establish hospitals staffed by medically qualified doctors.

      The fact is that the Committee of Science and Technology agreed with you and this Government and the last one agreed with me. QED

  9. Andy Lewis August 30, 2010 at 5:09 pm

    Again, you don’t really address the point about how you would choose what it is OK to fund on the NHS. You just suggest that if a ‘significant minority’ want something then they should have it. This just raises obvious questions about how ‘significant’ that minority should be and what should be done if that minority can be shown to hold harmful or nonsensical views (as will undoubtedly happen.) Should the tax payer fund anything as long as some threshold of demand is registered, no matter how absurd or harmful?

    To answer your questions…

    1. My main argument against NHS homeopathy is that its status is then used as an imprimatur by non medical homeopaths to do outrageous and dangerous things both here and abroad. I am not too concerned about doctors using it as a placebo. Although, I would make a case that if a group of doctors are behaving as if it is not a placebo then the government and other authorities have a duty to step in – as they would do in any other scenario when incompetence or delusion was threatening public health.

    2. I make no double standard and would demand that any publicly funded treatment had the backing of appropriate levels of evidence to support its use. That goes for SSRIs, homeopathy and anything else. (By appropriate, see here: http://tinyurl.com/quackquads).

    There is so much heat on homeopathy because if, as a society, we cannot sort out this obvious nonsense then we must surely fail at the more subtle (and urgent) problems posed by real pharmaceuticals and treatments and the difficulties posed by Big Pharma in their marketing of them. Homeopathy is a pons asinorum. Let’s get it out of the way.

    3. The historical argument is obvious nonsense. If historicity was a major determining factor in what we should fund then out go all modern outpatients, surgery and diagnostics facilities and most pharmaceuticals including antibiotics. And we keep our asylums and polio wards.

    And as you well know, the homeopathic hospitals were included in the vast settlement with doctors in 1948 as part of the giant compromise with a hostile medical profession. It does not mean homeopathy works. Indeed, all these facilities have now dwindled to mere vestigial stumps of what they were in 1948. Little rooms in annexes of once grand institutions. The MPs asked merely to put them out of their misery.

    It is clear you are desperate read the governments response as if they were in agreement with you. We shall see what real impact their inaction has. I suspect it will be business as usual as PCTs and their successors cease the last drips of funding for this superstition.

    • Dr. Kaplan August 30, 2010 at 5:54 pm

      @ Andy Lewis You accuse me of ‘not really addressing the point’? What about you not addressing my points in your answers?

      1. I know you are ‘against NHS homeopathy’ but your answer doesn’t address my point that I considered it wrong to attempt to thwart rather than dissuade NHS GPs from referring patients to NHS homeopathic hospitals. Your campaign should have been addressed at NHS GPs. The attempt to control and coerce them was ignoble, illiberal and undemocratic imo and I think that this Government and the last agreed with me.

      2. I disagree. If you want a certain standard of evidence for an intervention to be included on the NHS then state that level of evidence. One standard of EBM for all proposed interventions – Or is that too much to ask? – if you propose to elevate EBM above the clinical opinions of GPs which are made about cases they know more about than anyone else. Medicine is an art in which you deal with people as well as their illnesses. However if you want to stick to a deterministic and mechanistic view of health and medicine then why not campaign FOR the universal adoption on the NHS of Evidence Based Medicine, rather than AGAINST any particular form of intervention that you happen personally to disapprove of?

      3. History does put to us the question: To whom do those homeopathic hospitals belong?

      We obviously disagree on many points here and I would happily debate this with you (or anyone else) live, but as I’ve said I’m tired of blogging on this issue any more. The report of the Committee of Science and Technology was a poor document in my opinion; the last Government found it ‘illiberal’ and the present one comprehensively rejected its recommendations and that is now history.

  10. paul August 30, 2010 at 5:32 pm

    Hi Brian,

    Patiently waiting for Andy’s rerply??? In the meantime well done for taking the time to write your post and the replies to the comments.

    @Andy. The question is how reliable is any evidence? Clearly most drug trials are funded by those with a vested interest. I shall repost the link I posted earlier.

    http://www.eurekalert.org/pub_releases/2010-08/asa-pam081010.php

    So what in your opinion would be the % of treatments that are currently used that meet your criteria of having good evidence? Or is the real issue for you that it is far easier to lambast something that is implausible?

    • Dr. Kaplan August 30, 2010 at 8:58 pm

      @ Paul. We must always listen to what others say and respect their point of view. That’s why I try to reply to all comments. Of course much of conventional medicine lacks solid evidence – as my PIe Man illustrates by delivering that pie chart composed by that biased, pro-homeopathic, irrational publication – The British Medical Journal’s Clinical Evidence 🙂

  11. Andy Lewis August 30, 2010 at 7:12 pm

    1. I did rather mention why NHS homeopathy should be thwarted (your word). Homeopathy is a delusional belief system (or maybe in a minority of cases, a fraudulent belief system). NHS Doctors who work in the NHS Homeopathic hospitals are not going to say “You’re right! It is rather absurd and I have been kidding myself with regression to the mean and all the other biases…” No. And indeed. The MP report was just one aspect of a large number of actions that many individuals have been involved in to raise the issue. Doctors have been engaged in through debate (most recently at the BMA conf.) Pharmacists have been challenged and patients encouraged to find out what they are getting involved with. The Evidence Report does not exist in isolation as a sneaky undemocratic act of thwartation – if I can use that word. Far from it.

    But there are a few die hard homeopaths who will cling to their 18th Century healing fantasies no matter what. It is quite right in those circumstances to ask if government wants to intervene. The government agreed with most of the points – but chose to leave it to PCTs to do the assessments.

    2. I am not sure what you disagree with. Do you really demand the same level of evidence for all interventions? DO you want to see RCTs on bone setting before you will plaster a persons leg? Appropriate evidence for the scientific context is sufficient for me. For homeopathy, the level of evidence has to overcome the magical implausibility of what you claim. Some basic experiments to show what you claim has a foundation might be a good start. Like some evidence provings work, for example.

    EBM is about combining the best available evidence with clinical decisions. It would appear that its opponents want to ignore science and evidence when it does not fit with their pet therapies. There are plenty of people who to to highlight the need for EBM in the NHS – to say we do not is a straw man.

    3. Who do the hospitals belong to? Certainly not the homeopaths. They cease to have a right to practice their nostrums there when they cannot demonstrate that anything they say is true. It does not matter how ‘historical’ these few sites are (and it is only London that remains in a small corner of its original building), if they persist in pushing superstition, then the tax payer need not fund it.

    And of course, none of this affects people like you who choose to practice privately. I fully support your freedom to sell whatever you like to you believing customers. That is a different issue. But I would rather not the NHS was endorsing what you choose to do by pretending it is real.

    • Dr. Kaplan August 30, 2010 at 8:42 pm

      @ Andy Lewis It is utterly clear that we have a different philosophical perspective on this.

      1. I know you think NHS homeopathy should be thwarted. But I asked the question why you chose to thwart (rather than dissuade) non-homeopathy practising GPs who want to refer patients to homeopathic hospitals. Nobody has answered that question perhaps because they don’t want to appear as authoritarian as they really are. I repeat: The campaign would have been at least honorable if it had sought to win those NHS GPs to its point of view instead of trying to persuade non-medically qualified legislators (and that includes PCTs as well as the Government) to go over their heads.

      2. I do expect the same level of evidence for SSRI anti-depressants as for homeopathic remedies – if a level of evidence is going to be set across the board. Unlike your example of bone-setting, that is a reasonable comparison to make.

      3. I disagree. The absolute worst thing that can be rationally said by homeopathy’s critics imo is that it’s the careful history taking and empathic bedside manner that gets patients better. I don’t agree with that but even if it were true it would not be a good reason to cut funding for NHS homeopathy. It would be a good reason for people to study the

      I guess we have taken this as far as we can and must agree to disagree on this. The Government agreed with me on this one and the previous Government hinted strongly that it would have done so too when MIke O’Brien described the recommendations to cut funding for NHS homeopathy as ‘illiberal’. But there are indications in the zeitgeist that liberty may have had its day and who knows, the next Government may agree with you. Que sera sera.

      Perhaps you will allow me the last word on this as it’s my blog. But I will still publish any comment you make because I’m a libertarian kind of guy.

  12. paul August 30, 2010 at 10:28 pm

    Hi Brian,

    It is not just the lack of solid evidence as the pie chart shows. It is also the fact that a lot of evidence is corrupted and distorted. And as Andy has pointed out, people do not like to admit that what they’ve been doing is wrong.

    “For homeopathy, the level of evidence has to overcome the magical implausibility of what you claim” Surely that statement sums up all that is wrong with thos who argue against homeopathy. They are happy to ignore the lack of “good quality evidence” and the distortion of evidence into the effectiveness of conventional practice. Yet when it comes to something that they have no understanding of they throw their hands up in horror saying there is no evidence. It is interesting to see that Mr Ernst who has long presented himself as the perfect person to criticize homeopathy as he has studied and practiced, was in fact making it up.
    Original here
    http://www.dzvhae.com/portal/pics/abschnitte/300410102802_hn168april10.pdf?PHPSESSID=273eb20b3c19d743c6c106bbd56fd1dc
    translation here
    http://www.hmc21.org/#/edzard-ernst/4543212059

    Clearly things are not what they seem.

  13. Andy Lewis August 30, 2010 at 10:28 pm

    @Paul

    Yes – there is much we could agree on about the evils of Big Pharma including the extraordinary waste, as highlighted in your link, of companies concentrating on ‘me too’ drugs rather than genuinely novel interventions. None of this though lets homeopathy off the hook as when the same standards of enquiry are held up to homeopathy, it is clear that it is nonsense on stilts.

    So, how reliable is any evidence? A good question again, and evaluating treatments at the best of times is hard – worse when pharma companies distort evidence, deny evidence of obfuscate. The MP report castigates homeopaths for taking misleading approaches to evidence:

    “We regret that advocates of homeopathy, including in their submissions to our inquiry, choose to rely on, and promulgate, selective approaches to the treatment of the
    evidence base as this risks confusing or misleading the public, the media and policymakers.”

    @DrKaplan – I thought I made it cleat that the critics of homeopathy have engaged in discussion with doctors, patients and the public and the MP report was only strand of a large debate. It is therefore very unfair to characterise your critics of being ‘undemocratic’ and trying to ‘thwart’ homeopathy on the NHS. Homeopaths have had plenty of chances to enter into debate. Few do in any meaningful way. And for that, at least I would thank you.

  14. paul August 30, 2010 at 10:50 pm

    I meant to add this to my last post. It is an interesting critique of the peer review system. It makes interesting reading and should certainly make anyone with an open mind question how the scientific community works.

    http://books.google.co.uk/books?id=Xfsh6D29WoIC&pg=PA1&dq=%22is+peer+review+good+for+science%22#v=onepage&q&f=false

    Like yourself I believe the evidence of my own experiences combined with the evidence of countless others. To dismiss it as delusional strikes me as haughty and arrogant. Are you reading this Andy?

    • Dr. Kaplan August 31, 2010 at 12:36 am

      @ Paul Both the links you cite are fascinating. Thank you for your contribution here. Everything is indeed not as it seems in this ‘insubstantial pageant’ we call ‘life’. Perhaps we all have only a little of the truth and should remember that more. My personal experience is that the doctors I have met who practise homeopathy have been somewhat more philosophical and thoughtful (and perhaps more pantheistic) about life itself than those who have not studied it – but of course that is just my experience and I can rightly be accused of not having peer-reviewed, evidence-based studies to support such an outrageous assertion. And with that, I’ll quote my very favourite few lines from one of England’s wisest sons. Sleep well.

      Our revels now are ended. These our actors,
      As I foretold you, were all spirits and
      Are melted into air, into thin air:
      And, like the baseless fabric of this vision,
      The cloud-capp’d towers, the gorgeous palaces,
      The solemn temples, the great globe itself,
      Yea, all which it inherit, shall dissolve
      And, like this insubstantial pageant faded,
      Leave not a rack behind. We are such stuff
      As dreams are made on, and our little life
      Is rounded with a sleep.

  15. Adam August 31, 2010 at 10:52 am

    Democracy, while probably the least awful way to run a country, is really not a great way to settle scientific disputes.

    It was once the democratically legitimate view that the sun orbited the earth. Do you really think democracy is the best way to decide about scientific issues?

  16. Adam August 31, 2010 at 12:27 pm

    Ah, and I see you’re using the same straw man argument against Andy that you used in the post I commented on the other day.

    You seem to think that all detractors of homoeopathy are keen to see non-homoeopathic ineffective treatments funded on the NHS. Why do you think that?

    I would love to see all ineffective treatments removed from the NHS, homoeopathic or otherwise. I’m pretty sure most of those skeptical of homoeopathy think likewise. Do you have evidence to the contrary?

    • Dr. Kaplan August 31, 2010 at 9:27 pm

      @Adam: Although I’ve finished debating this with Andy, I’m certainly not finished with you given your last three comments:

      1. Re: Strawman arguments and what the skeptics ‘think’:
      My case is no strawman; it’s an expose of the application of blistering double standards.
      I have never said that ‘that all detractors of homoeopathy are keen to see non-homoeopathic ineffective treatments funded on the NHS’ I’ve simply made it clear that it’s blisteringly hypocritical to use EBM to attack homeopathy and CAM exclusively on the basis of ‘lack of evidence’ esp. when the budget for non-evidence based conventional approaches such as SSRI anti-depressants (for mild and moderate depression – a massive cost to the taxpayer and whose budget dwarfs homeopathy’s by about 20 to 1) is huge compared to that of homeopathy. Homeopathy’s detractors may not support these non-evidenced interventions but where is the vicious, sneering, jeering, deriding and denigrating campaign against them and attempt to thwart qualified doctors from prescribing them or referring patients for treatment for them? Show me ‘evidence’ for psychoanalysis (for which I have some sympathy) and many psychiatric interventions that cost the taxpayer a small fortune? Have a look at some surgical interventions for back pain too. Maybe you skeptics would like those removed too but just couldn’t be bothered to mount a nasty media campaign against them? Is it really a strawman argument for me to say that IF a certain level of evidence-based medicine is to be used as a test for inclusion on the NHS – it should be used across the board on ALL interventions. Yes or No, Adam?

      People are free to ‘think’ what they want but how they act affects others. You say: “I would love to see all ineffective treatments removed from the NHS, homoeopathic or otherwise. I’m pretty sure most of those skeptical of homeopathy think likewise. Do you have evidence to the contrary?”

      No I don’t have ‘evidence’ about what these selective skeptics ‘think’ but how they act is self evident.
      1. A bunch of eminent doctors and scientists including Ernst, Baum and Colquhoun writes two letters to all the PCTs (one inappropriately on NHS notepaper) inviting them to thwart local GPs from referring patients for NHS homeopathic treatment. They have nothing to say about huge swathes of orthodox NHS interventions not being based on evidence.

      2. A bunch of jeering youngsters wearing incredibly naff T-shirts saying 10:23 on them have nothing better to do with their lives than mount a nation wide protest against others irrationally benefitting from NHS homeopathy while having nothing to say about much more expensive non-evidenced based conventional medical interventions.

      3. The media join the circus and give far more time to our critics than to us.

      All this left a very false impression in the public’s mind and in the mind of those NON-MEDICALLY QUALIFIED members of PCTs, that ‘surely with all this calling for homeopathy to be banned on the NHS because we are told it lacks the requisite evidence, all of orthodox medicine MUST therefore be based on evidence when nothing could be further from the truth.

      I, apparently highly controversially and definitely irrationally and non-scientifically, like to leave clinical decisions about treatment of their own patients to doctors. But if EBM is going to be used in an authoritarian way, then surely it must be used across the board? Do you have a problem with that Adam? You say: “Do you think anyone is attacking homeopathy on that basis while simultaneously trying to defend other treatments that have been shown to be ineffective? If so, perhaps you could cite examples?” No they don’t defend these other MORE EXPENSIVE non-evidence based other treatments – they simply don’t say anything about them at all and certainly don’t organise an orchestrated attack on them. In other words their (relative) silence on these – in the context of the vehemence of their attack on homeopathy- gives consent to all the expensive ‘orthodox’ and ‘scientific’ but non-evidenced based interventions that are funded by the NHS.

      2. On democracy:
      a) This isn’t a ‘scientific dispute.’ Medicine is an art based upon science. (Thus spake Osler who was probably more scathing of the physicians of his time than the homeopaths) Human suffering and it’s alleviation will never be fully understood by science alone, just as love never will – and yes love has healing capacity too.
      b) The democratic process is there to consider what science has to say and then decisions will hopefully be made by a government of, for and by the people. Of course there have always been those who don’t agree with this and think that their interpretation of science should be foisted on the people by ‘government’ but usually a dictator who pontificates: “I know better than you what’s good for you!” Good example – Josef Stalin

      Thank Heavens neither this Government nor the last has sunk that low and in kicking the dreadful scientistically-driven, inhumane, uncaring, biased recommendations of that awful report (read Earl Baldwin’s view on it – referenced in the Comments section here) into touch, they salvaged a lot of my respect. But who knows, the next Government may sink into the swamp of totalatarianism and populism and fail to treat draconian and undemocratic ‘recommendations’ such as those made by the Science and Technology Committee, with the contempt they fully deserve.

      Thanks for those comments. I have to admit I do feel better for answering them and can now move on to what I really would like to blog about.

  17. paul August 31, 2010 at 8:25 pm

    Sorry Andy I think the article was about more than just waste and me too drugs.

    “Despite the extensive requirements for testing the efficacy and safety of each new drug, companies “swamp the regulator” with large numbers of incomplete, partial, substandard clinical trials, Light said. For example, in one study of 111 final applications for approval, 42% lacked adequately randomized trials, 40% had flawed testing of dosages, 39% lacked evidence of clinical efficacy, and 49% raised concerns about serious adverse side effects, said Light”.

    Your evaluation is interesting to note especially as you seem so quick to evaluate the quality and effectiveness of trial of homeopathy. I would say that as with the peer review process which is obviously geared to maintaining the stauts quo, funding for research into alternative modalities is woefully inadequate. Without being able to find the link there was a wonderful quote that is related to this idea. A research when talking about being asked to look into homeopathy indicated that he would very likely become unemployable if he did. Rather like old Dr Burnett who when talking to one of his professors he warned him that his ‘conversion’ was tantamount to professional suicide since a major career in medicine would be denied to him. He went on to become a great homeopath. The key point here is that “going over” to look at the other side would have wrecked his career. Things haven’t changes as there are people like Mr Lewis and co who still believev that it is all charletinism and that it cannot possibly work.

  18. Sastry.M September 1, 2010 at 8:16 am

    Dr.Kaplan-Your latest comment ending with ‘sleep’ well poem is most revealing.Many evolved animals have mind with an embedded intelligence for survival and intuition for procuring food as well as self protection. So are we
    human beings among the many species inhabiting the earth possessing a unique mind that is always disingenuous to external expressions and inner intentions and yet physically belonging to mammalian species. Why is it so? Man in physical stature is analogous to mind and mind is the representative of consciousness whose domain of activity is thoughts and whose seat of encampment is the physical brain. This evidence is clear and universally accepted because all human actions are guided by mental directives. If physical evidence is a necessary prerequisite of mind located in brain can we procure it by its vivisection? A scientific discipline of study,however,has been built up locating areas of brain causing mind revelations and physical sensations of/as differing reactions to the same mild electrical stimulus.
    Now the question is who was created first–mind or human being? If man has appeared as part of natural creation in general what is the unique feature of human beings and how is it distinguished from the rest of intelligent animals? Usually we take many things for granted before we subjectively direct our mind to evaluate any evidence or initiate a phenomenal study. What we basically take for granted is our directive and analytically differentiating mind- resulting in short a capability to say “Man can Definitively Measure”.Although man has such a unique mind it in itself is incapable of operating independently unless sensitized by consciousness. To be alive in body we need consciousness in all three states.Viz. wakeful,dream sleep and deep sleep states. Only then can we respond to any brain based studies.
    Because brain is composed of materials whose basic and intrinsic structures are responsive to electrical stimuli can we accept this as a basis of common evidence to generalise on mental responses of different individuals although the physical reactions as noted by body reflexes may fairly comply to the same stimulus? Also comparing analogously consciousness sensitizing mind and electricity stimulating brain we can obviously establish the pre-requsite of a consciously wakeful person to evidence the course of experiences and noting results of a study.
    However individual responses of mind generated pictures differ in different persons to the evidence of same observable brain stimulus as cited above proving the fact that mind generated responses need not be rational while the physical can be definitively observable. If we say that man can only measure definitively then we have to condition our minds to experiences that can be definitively observable. The basic conditional domains are Space and Time and the mind perceptible transformations are physical magnitudes and chronological activities respectively. Both are interrelated because the mind consciousness is the same while the phenomenal observations are differentiated orthogonally by mind.
    Suffice it to say that all these capabilities assist man to train his mind rationally and logically to conduct all scientific pursuits while at the same time fall helplessly prey to pre-set mind conditionings because of the basic transcendental nature of mind failing to grasp the overview of harmony in all natural creation in spite of scientific and technological advancements as evidenced by present day polluted environment and corrupted mind catastrophes.

    • Dr. Kaplan September 1, 2010 at 10:30 am

      @Sastry. M What you say brings to mind the words of a yogi that I heard once and never forgot: ‘In rock, consciousness is asleep, in plants it is dreaming, in animals it is awake but in humans it is rising’ A good modern book that put these sort of things into perspective is John Rowan’s The Transpersonal – which I intend to review at some stage on this blog.

    • Dr. Kaplan September 1, 2010 at 9:29 pm

      @Sastry. M Thank you for that and hope it was a good day. I’ve read the Gita and know something of Ramana Maharshi, Ramakrishna and Sivananda. Also Jiddu Krishnamurti was a big influence on me.

  19. Sastry.M September 1, 2010 at 6:59 pm

    @Dr,Kaplan-
    Sir, we in India are celebrating today,the 1’st.Sept.’10 the birth of Lord Krishna Who sojourned the earth Ca.3100 B.C.In his greatest exposition the Gita all aspects of Creation being projected as in a dimensionally bounded phenomenal activities were inferred to an absolute and dimensionless entity known as Brahman or Pure Awareness thus laying the foundation of Advaita or Monistic Philosophy as referred to human Mind Concepts. These appear abstract and hazy because our minds are activated and conditioned by a conscious process that is implicitly taken for granted and axiomatically accepted before directing subjectively to any phenomenal observation. This is the conceptual basis of the west i.e. taking mind and consciousness as a single and indivisible entity in all activities of cognition and recognition. However due to heat stroke or intense contemplation on a particular subject we may temporarily become oblivious to busy external activities or become ‘unconscious’ to them.We recover our consciousness and become normal gain. Close observation of this interruption in cognitive activity reveals that mind activity and conscious activity can behave as if they are independent entities although consciousness is present always as long as a person is alive. Can we take this statement as axiomatically acceptable? No because this temporary interruption in an emergency of cognitive break can naturally occur during a sleepy wink or retiring to nightly sleep. During deep concentration of a directed thought activity or during sleep we withdraw into ourselves all external cognitive activities and yet retaining autonomous body consciousness through mind generated pictures of dream forms or simply day dreaming during wakeful state. What is happening? In non-wakeful state the mind puts time related conscious (chronological)activity to a temporary cessation or collapsing the dimension of time retaining only space related forms. This is an entirely mind generated abstraction of conscious activity which in wakeful state results in pure logical thinking being coupled with rationally recognizable thought patterns and hence reasoning by use of mathematical symbolism. All this discussion points to show the difference between subtle activities of mind of inner conceptual world and cognitive activities relating to gross external physical world.
    Again differentiating between inner and external in a subtle manner we find by the above narration that Consciousness is Independent of mind generated activities although it is required by sentient mind to keep going in a dependent manner by psychically interfacing with electromagnetic cellular activities of physical brain resulting in an activity known as psych-somatic. This is true of all sentient living beings capable of self expression of intelligent activity. The matter does not end here however but only begins initiating spiritual and scientific human inquiries.
    As reminded by the words of a Yogi we can modify his observations in view of above discussion by saying that in rock consciousness is active but is dormant and incapable of sentient expression; otherwise we could not have generated models for atomic theory or produced electro or permanent magnets to generate electrical power for daily use. In plants it is awake and sentient because they procreate through respective seeds and bend towards sunshine when reared in apartment balconies. In animals it is both awake and dreaming because they display an ego generated fear of self protection keeping constant vigil and camouflage with habitat.They also sleep in their own postures and may dream but as we humans can surmise it may be an extended hibernation during active wakeful state also because they seem to be oblivious to trans formative empathy and cannot express emotions or their years of living.
    To wind up this long rhetoric a study of Gita with commentaries by any famous author and a reading of The Teachings of Ramana Maharshi edited by David Godman and published in Penguin Books for inner self inquiry are highly recommendable.

  20. Adam September 1, 2010 at 9:42 pm

    It’s really a matter of opportunity and priorities. Homoeopathy has been in the news because the government have been saying silly things about it.

    I doubt that anyone has the time to campaign against everything at the same time. But there was a good opportunity for a campaign against the ludicrous waste of public money on one particular kind of treatment that does not so much lack an evidence base as have a huge evidence base showing it to be ineffective.

    Interesting that you think these kinds of things should be settled democratically. I disagree. Technical decisions on matters of science (perhaps the bit where we disagree is to the extent that medicine is, or should be, based on science) should, IMHO, be delegated to those qualified to judge them.

    Anyway, glad you feel better for having answered my points!

    • Dr. Kaplan September 1, 2010 at 10:19 pm

      @ Adam: “a huge evidence base showing it to be ineffective.” Is that so? I thought outcome studies showed that people visiting homeopathic hospitals were very satisfied with the results and even our critics agreed people improved but thought it was due to bedside manner, placebo effect etc. But who cares about those people? Certainly not you, a person unlike me and unlike this government or the last, who is ‘qualified to judge’ these matters.

  21. paul September 1, 2010 at 9:53 pm

    @ Adam

    I finally got it, you’re practicing using peovacative therapy. After all you post is too ludicrous to be taken seriously

    • Dr. Kaplan September 2, 2010 at 8:59 pm

      ‘preovacative therapy’? Do you mean Provocative Therapy? ‘After all you post…’ ? ‘your post’? ‘ALL I post’ ?

      Sorry I do require comments to be written in intelligible
      English if a response is required. Could guess the meaning but couldn’t be sure at all.

  22. Andy Lewis September 1, 2010 at 11:52 pm

    Dr Kaplan

    Did you read the bit in the MPs report a bout the inherent problems with outcome and patient satisfaction studies? Paras 41-44, eg.

    “The patient’s perception of the quality of the consultation and whether a course of treatment has been prescribed may contribute to patient satisfaction, irrespective of whether the treatment itself is effective”

    If you did read it, how do you respond?

    If not, why have you not read the report?

    • Dr. Kaplan September 2, 2010 at 7:02 pm

      @ Andy Lewis: Sorry there is a limit to how much I can debate this with you. I did read the report. I also read Earl Baldwin’s critique of it which you should read too. Of course what you have quoted is true – but what they then went on to say about the ‘integrity of the doctor patient relationship’ was pure sophistry and drivel. Not ALL the discussion in the report was utter and complete rubbish, but its recommendations stank – according to me, supporters of holistic medicine, this Government, and the last one.

  23. Adam September 2, 2010 at 12:43 pm

    Yes, there is a huge evidence base showing homoeopathy to be ineffective, as I’m sure you know. There have been many systematic reviews, and even a systematic review of systematic reviews. The conclusion from them is clear: homoeopathy is no more effective than placebo.

    The outcome studies you talk about are uncontrolled, and so are incapable of providing any evidence about efficacy. Any improvements seen are indeed due to either placebo effects or regression to the mean.

    • Dr. Kaplan September 2, 2010 at 6:56 pm

      @ Adam: I disagree with every point you make here and I do not ‘know’ that there is a huge evidence base showing that homeopathy is ineffective. I also do not understand what you mean by ‘improvements seen’ being ‘due to….. regression to the mean’.

  24. Sastry.M September 2, 2010 at 3:42 pm

    @Dr.Brian Kaplan-In my opinion we have to clearly distinguish between Evidence and Basis pertaining to matters of evidence base priority. A mere detectable evidence of a medicinal substance in vivo need not satisfy all clinical as well as diagnostic requirements in combating a patient’s disease. This is because adaptability is an observable primary necessity for maintaining healthy life and overcoming disease. If medicinal strength is relied upon as a basis to bear the combative brunt against disease the biological basis of patient will be shifted to a secondary place and genuine biological needs may be overlooked Also repeated dosage of even of a well selected drug to maintain clinical therapeutic level until achieving a successful campaign against disease may effectively over come that particular cause but leaves many debris as a result of co administration with other drugs treating other diseases. In the aftermath of a successful remedial action the biological system will be forced to take stock of results against violent acute and sustained chronic treatments and devise its own autonomous methods to combat left over drug reactions depending on constitutional sensitivities of patient. Thus phlegmatic temperaments may develop immunizing programmes while sanguine may decide for allergic reactions. Also pathological degenerations may place extra caution on diagnostic shrewdness of doctors of medicine not to speak of co administered drug contra indications. Finally wisdom gained by all painstaking research and advances addressing the full spectrum of medical field by EBM does not allow doctors to heave a sigh of relief for inadvertent human mistakes against harm caused by improper drug selection as well as administration.
    I have poured some lava of rhetoric recently on homoeopathic witchcraft prepared from Ph.K and Ph.D processes also. Thanks for your patient reading and kind response of understanding.

  25. Andy Lewis September 2, 2010 at 6:59 pm

    Dr Kaplan,

    Are you not responding to me?

  26. Adam September 2, 2010 at 7:14 pm

    For the evidence base showing homoeopathy is ineffective, you should read this:

    http://www.ncbi.nlm.nih.gov/pubmed/12492603

    For an explanation of regression to the mean, try this:

    http://ije.oxfordjournals.org/cgi/content/full/34/1/215

    • Dr. Kaplan September 2, 2010 at 9:12 pm

      @ Adam The first article by Ernst is very bad and I’m well aware of how he has found his niche as the Professor of CAM that trashes CAM in his blog on Pulse. As I’ve said holisitic individualised medicine needs a different testing system from the RCTs used to test a single drug against a single condition.

      The second article is very good and I now see what you mean about how regression to the mean may sometimes explain apparently good results in non-repeated study. Nevertheless Peter Fisher and many homeopaths who know something about studies maintain the most meta-analyses show homeopathy having an effect over and above the placebo effect. It’s not exactly my area but I know there have been accusations of cherry picking on both sides of this argument.

  27. paul September 2, 2010 at 8:34 pm

    Hi Brian,

    I think what Adam means is those people who got better would have got better anyway. I’m not sure if you’ve ever looked at Bradfords “Comparitive results of homeopathic and other treatments”. What Adam means is that all those who, were treated homeoepathically, and then survived or recovered from various complaints such as cholera, typhoid, Yellow fever, diptheria etc would have done so any way. And those who were treated conventionally and didn’t survive or recover were in fact killed or made worse by their treatment.

    To Quote

    Dr Wild an eminent allopathic surgeon, editor of the Dublin Quarterly Journal Of Medicine, in his book on “Austria, its literary, scientific and medical Institutions” has these words: “Upon comparing the report made of the treatment of cholera in the homeopathic hospitals of vienna with that of the other hospitals at the same time, it appeared that while two thirds of those treated in the homeopathic hospitals werer cured, two-thirds of those treated in the other hospitals died”. On account of this extraordinary result the law interdicting the practice of homeopathy was repealed. This homeopathic hospital, was daily visited by two allopathic physicians appointed inspectors by the government, who confirmed this report. Moreover, many of the cholera statistics in this report are taken from the pamphlet of Dr Roth, an opponent of homeopathy, who was sent by the government of Bavaria to observe this epidemic in different localities, and report on the best treatment.
    Page 113

    Old news perhaps but facts is facts

  28. paul September 2, 2010 at 8:44 pm

    Excuse my going on but forgot to add.

    Yes a third of those treated homeopathically died. Why is that? Well the answer, I guess would be what has been the single most important thing that has occured to improve the health of society? Of course it is neither homeopathic or conventional medicine. It is as we are all aware improved sanitation and general hygeine, which includes diet.
    Has anyone ever conducted an RCT on this area? It may be that it is all down to placebo! People feeling better because they’re living in better houses and eating nice food and their shit isn’t looking at them from where they left it or making the rivers smell.

  29. Adam September 2, 2010 at 9:27 pm

    I think I see your point about the way RCTs are done. You believe that homoeopathic treatment has to be tailored to the individual, so giving everyone with the same conventional diagnosis the same homoeopathic remedy would be pointless and doomed to failure from the start. Have I understood correctly?

    That, however, doesn’t preclude RCTs. You could easily devise an RCT in which everyone is prescribed an individually tailored homoeopathic treatment, and then the prescription is given to a homoeopathic pharmacist who has the randomisation code, and would either dispense the remedy as prescribed or placebo. It could all be done in a perfectly high quality randomised and blinded manner, while staying entirely consistent with the homoeopathic principles of individualised treatment.

    I think I did actually hear about such a study once, and seem to remember the results were negative, although sadly I can’t remember the reference.

    Do you know of any such studies that have been done? And if not, why not? If the homoeopathic community are convinced that they have something that works, I would have thought they would be keen to demonstrate it by RCTs designed with the principles of homoeopathy in mind.

    As for most meta-analyses having an effect over and above placebo, you’re just wrong about that. The whole point of the Ernst article is that it reviews all the systematic reviews that have been done, and they are overwhelmingly negative. I think relying on a systematic review of systematic reviews is the best possible defence you could wish for against accusations of cherry picking.

    • Dr. Kaplan September 2, 2010 at 9:58 pm

      @ Adam Re: first paragraph of my last comment to you. Yes you have indeed understood correctly.
      Re: your study design: That is absolutely correct. You would give the homeopathic prescriber permission to prescribe whatever he wants but 50% will get placebo. Problem tends to be expense. You need an hour for that first consultation and half an hour for follow-ups which is standard homeopathic practice. Still I agree it is possible. The problem is who will do it and where? Can’t be done on NHS patients seeking homeopathy. Sponsors will be very hard to find because a positive result would simply be a positive result for homeopathy as an entity and not for any one marketable medicine. You may think this is not a good reason for a trial but do the sums and ask yourself where the money is coming from. My idea of a good trial would be to have an NHS clinic doing psychosomatic medicine (same time spent with patients as the homeopaths) and compare results. That way you don’t need to use placebo which really is a problem for the reasons I’ve given here.

      I can’t get into a discussion about the meta-analyses. It’s not my field but I do know that Peter Fisher, Robert Mathie and others do not agree with your interpretation of the results. Sorry but I don’t have the expertise in that area – but I’ve read enough to convince me that it is controversial.

      I also happen to believe that the fact that millions of people (eg in India) have benefited from homeopathy for 200 years is a form of ‘evidence’. I don’t know HOW it works but work it does for me in my clinic – so that is good enough for me as a doctor who has looked after some patients for nearly 30 years and seen them through pregnancies, births and many illnesses. I also am a libertarian and democrat and detest authoritarian style politics.

  30. paul September 2, 2010 at 10:19 pm

    Hi Brian,

    Ah yes apologies for the dreaded typo!!! I am a one handed typer from a long past accident. I grew up in an age when communicating was primarliy done by voice, apart from the non verbal stuff.

    @Adam,
    Your question about individualised RCT is perfectly vslid. But how much would a good quality trial cost? Probably as much as the entire yearly NHS homeopathic budget. So is it goinG to happen. No it isn’t.

    • Dr. Kaplan September 3, 2010 at 11:24 am

      @ Paul. Yes I thought the same. And as Adam is honest enough to admit, it wouldn’t convince him until it was repeated and even then it wouldn’t be totally convincing. I’ve made it clear here that practising as a doctor and fighting the battle on the political front is enough for me. I have to leave trials, analysis of data etc. to others. But he has a point. With a huge legacy from a benefactor we could do this sort of trial. Know any billionnaires that were cured with homeopathy that want to invest?

  31. Adam September 3, 2010 at 9:22 am

    Yes, it is expensive to do good clinical trials. Still, it surprises me that the homoeopathic community haven’t found the money from somewhere: if enough of you really believe that such a trial would show positive results, then it could be a real game-changer. And plenty of trials in homoeopathy have been done, so there must be some money for it somewhere. If a sufficiently large and well designed study of the type we’ve talked about were to give positive results, that would make me start to question whether I have been right to dismiss homoeopathy as no more than a placebo (although I’d probably need to see several such trials give positive results before I’d be totally convinced, as the results of a single trial are almost never convincing, no matter what the intervention being investigated).

    Maybe you should be pestering folks like Boiron to come up with the money. I’m sure they could afford it. Or perhaps you could set up a fund and invite homoeopathic practitioners to stump up a bit each? After all, if you believe it really works, you’d be happy to put your money where your mouth is, wouldn’t you?

    Anyway, if it helps, I’ll happily make my contribution by offering you 10% off our normal fees if you get get the funding for such a study together and engage my company to help run it.

    I think your other idea for comparing homoeopathy with psychosomatic medicine also has some merit, although the problem is that the act of putting a pill in your mouth is an important part of the therapeutic ritual and thus contributes to the placebo effect. If such a trial were negative, we would know that homoeopathy’s effects were exerted mainly or entirely by the patient-healer interaction (as that would be the same in both groups). However, if positive, we wouldn’t really know whether it was the extra placebo effect of swallowing a pill or a pharmacological effect of the homoeopathic treatment.

    This may be my last contribution here for a while, as I’m off on holiday after today, but I dare say I’ll be back another day. Thanks for taking the time to respond to my points, and it’s a pleasure to find a homoeopath who’s happy to engage in a reasoned and sensible argument about some of the points where we disagree.

    • Dr. Kaplan September 3, 2010 at 11:20 am

      Sure Adam, Have a good holiday.

  32. Dr Amit Habbu September 6, 2010 at 6:40 pm

    Do the trial in India, it will work out far cheaper and i would offer my services free. If someone can work out a good protocol, we could do it.

  33. Sastry.M September 9, 2010 at 2:06 pm

    Dr.Kaplan-Your observation that millions of people in India have benefited from homeopathy for the past 200 years since its introduction and hence can be taken as ‘evidence’ for its effectiveness statistically as a ‘fact’ in general as also from your own clinical practice for over 30 years in particular establishes convincingly the wide spectrum of Homeopathic Philosophy for human condition in health and disease and its irrevocable Law of Therapeutics as a medical practice. The fight raging at present for/against homeopathy may be considered as a final attempt initiated by Providence to raise the awareness of public in general to choose between the authoritative and alternative modes of treatment for suffering and decide the efficacy of benefit themselves. Apart from the necessity of observable quantity of medicine as evidence and its non availability considered as mythical placebo which as a bone of contention in the west are both acceptable to the Indian philosophy of life. This is because Indian philosophy infers both sentient cause of subtle projective nature and efficient cause of material support to the same basis of origin as evidenced by the thread spun from a tiny spider supporting its physical weight but quickly drawing the same into itself with a perceived threat. Another general observation from our western brethren in general and the British in particular is that “The more grotesque some thing as a phenomenon the more readily will it be accepted by the Indians” and hence placebo effect probably has far greater efficacy in restoring Indian health. By the above narrative I am neither provocative nor sarcastic but Implore our European counterparts to review homeopathy in all its totality without prejudice because it is, after all, they who invented and developed it among themselves and introduced in respective countries having convinced first of its reliability as developed nations before extending it to their earlier poor dominion millions.

    • Dr. Kaplan September 9, 2010 at 4:31 pm

      @ Sastry. M As always, your comments are most enlightening.

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