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Now the Swiss back Homeopathy!

Like the fella says, sickness in Italy for 30 years under the Borgias they had warfare, terror, murder, and bloodshed, but they produced Michelangelo, Leonardo da Vinci, and the Renaissance. In Switzerland they had brotherly love – they had 500 years of democracy and peace, and what did that produce? The cuckoo clock!

(Harry Lime in The Third Man)

Well, that and the world’s finest watches and chocolate, and – er  – banking by numbers – of course. Swiss medicine is also highly respected and multinational pharmaceutical companies have their headquarters in Switzerland.

Thus it was a delight and a surprise to read that the Swiss Government has produced an official report remarkably in favour of CAM and homeopathic medicine.   The report, recently translated into English, can be previewed here.  I am indebted to Dana Ullman’s excellent post in the Huffington Post for bringing the full details of this report to my attention. The report is described  as ‘the most comprehensive evaluation of homeopathic medicine ever written by a government.’

This was a full scale government report, somewhat more professionally conducted than our own  Science and Technology Committee investigation into homeopathy that thankfully had all its authoritarian and anti-democratic recommendations politely kicked into touch by our Government – in the name of democracy and liberty.

A few points that come up in the Swiss report:

  • Aprox. 50% of Swiss people have used CAM (Complementary and Alternative medicine) and value it.
  • Aprox. 50% of Swiss people prefer hospitals that provide CAM to one that exclusively provides conventional treatment.
  • 85% of Swiss people want CAM to be part of the national health service of the country!
  • Aprox. 50% of Swiss physicians think that CAM is effective.

Prior to this remarkable report published in German at the end of 2011, a national referendum on the subject had been held in Switzerland in 2009. Two thirds of the voters wanted homeopathy and some other CAM included in the Swiss NHS.

Heaven forbid we have such a referendum here! It might just show us the truth about what the British public really think about CAM and homeopathy. No let’s rather have another referendum on something really important – like the ‘alternative’ voting system.

The British Government has shown that its heart is in the right place with regard to homeopathy on the NHS. Still it could learn a lot from reading this Swiss Report and begin to integrate other forms of CAM into the NHS. Here is an informative clip of a talk given by my esteemed colleague, Prof. David Peters on this very subject.

By | 2012-02-20T15:04:58+01:00 February 20th, 2012|Current Affairs, Homeopathy|83 Comments

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83 Comments

  1. Andy Lewis February 20, 2012 at 6:33 pm

    I think that it would be wise not to take everything Dana “Darwin was a fan of homeopathy” Ullman says at face value.

    The report was actually not written by the Swiss Government, but by anthroposophists. Particularly, form a private university that specialists in training Steinerist medicine to students. Do you see the minor conflict of interest here?

    The report (have you read it) is right up your street. It casually dismisses the implausibility problem, makes handwaving appeals to quantum theory, spends an awful lot of time trying to rubbish RCTs, then uses very closely cherry picked RCTs to make its case.

    Simple self-serving propaganda.

    • Dr. Kaplan February 21, 2012 at 11:51 am

      Andy, the simple fact is that the report is pretty in line with what the Swiss public want. I would imagine that in that Swiss referendum, the compaign against homeopathy and CAM must have been pretty strong and not lacking funds. Nevertheless the public voted for CAM and homeopathy to be part of the Swiss NHS. That is the main reason I posted that article. If we asked the British public the same thing, I think there would be a substantial minority who would want CAM and homeopathy for themselves and another substantial minority would not wish to deny homeopathy and CAM on the NHS for others and thus vote in favour of retaining the homeopathic NHS clinics. In other words, even though science may seek to become the ‘new rock and roll’, scientism simply isn’t popular with the people. That is why it isn’t embraced by any major political party. QED.

  2. liana felton February 21, 2012 at 11:04 am

    excellent article dr k.

  3. Andy Lewis February 21, 2012 at 1:32 pm

    Of course, the Swiss do not have an NHS. They have mandatory private insurance where the Government sets what must be covered at a minimum by law. It is one of the most expensive health care systems in the world. The Swiss government are not keen to increase the cost burden by mandating wishful thinking as part of the cover, even if many people want it. They have set a challenged for the major forms of quackery to show robust results or they will not be covered. The homeopaths have until 2017 to do this.

    One can look at this report – written by supporters of homeopathy – as just one more shabby attempt to undermine what is meant by robust results in medicine.

    • Dr. Kaplan February 21, 2012 at 1:48 pm

      When our Government kicked the authoritarian recommendations of that discredited* S&T Committee into touch I would have been more than happy if they had commissioned the NHS homeopathic clinics to prove that homeopathy produces results. A prospective** 6 year OUTCOME STUDY would have been my recommendation and maybe another 6 years to confirm that patients looked after by homeopathic doctors really do do well – no matter HOW homeopathy works.
      That would be my type of robust result. Scientismists might disagree but I am more interested in clinical results than appeasing the Disciples of Scientism who I believe to be more interested in the affront to their ideology presented by homeopathy than in the health and well being of the British public.

      * if you think the word ‘discredited’ is unfair – just examine how many of the participating MPs actually signed that horrifically biased report.
      ** Prospective trials are perfectly acceptable to the medical profession – even if jeered at by scientismists.

  4. Andy Lewis February 21, 2012 at 1:44 pm

    You see, the point I guess that I need to make is that you democratic medical utopia has costs. And those costs will fall most heavily on the poorest in Swiss society. By mandating that the rich can have their complementary medicine covered by their insurance you increase the amount the poorest (and there are poor in Switzerland) have to pay. The government will not step in until you are paying 8% of your income. By increasing the minimum costs, you increase the number paying out large fractions of their salary and on taxes required to support the poorest.

    So there is a strong moral imperative to ensure that the cover offered only includes treatments that can be demonstrated to be effective – even if there is a majority who have no concern for this.

    That is what the Swiss government are asking for. I guess the political battle is far from won by the homeopaths, eh?

    • Dr. Kaplan February 21, 2012 at 2:04 pm

      Love to hear you talk about ‘costs’ Andy. Why don’t you campaign for a MASSIVE OVERHAUL of how anti-depressants are used on the NHS? Kirsch et al, in a huge meta-analysis shows that in most cases they are not working above the placebo effect.
      Total cost of NHS anti-depressives to NHS: £232 million – some time ago. (Homeopathy: £10m) The horror is that that figure of £232m is going up as prescription of these meds soars – as I’ve pointed out in a previous post.
      When the disciples of Scientism point out costs as a way of attacking homeopathy, they are being blatantly hypocritical. I don’t think they care in the least about the costs of CAM or the people whom it clearly benefits. Homeopathy is an affront to the ideology of scientism. That is what gets their goat and they can’t stand the fact that the public simply does not agree with them. Interesting how you don’t address the results of the Swiss Referendum on CAM, hey Andy. The Disciiples of Scientism always think their ideas should trump the democratic process. I say that although I agree with Churchill that the best argument against democracy is a five minute conversation with the average voter, democracy is still the best political system we have got even if it results in scientismists being dismayed when homeopathy is backed by governments and when Christian Democratic parties are elected to power.

      I maintain that much of CAM is highly cost effective and encourages the human side of medicine when patients are often give the thing they most need – quality time with quality practitioners. If doctors want to prescribe these medicines and are accountable for their actions then it is disgraceful that there are people who would seek to THWART rather than DISSUADE them from doing so. But we have covered this before and may have to agree to disagree on this point. The point being I favour liberal politics and the Disciples of Scientism favour highly authoritarian politics.

  5. Andy Lewis February 21, 2012 at 2:45 pm

    I believe the committee did ask NICE to review homeopathy.

    But you call for a prospective study which are known to carry significant risks of bias – that is making treatments look effective through regression to the mean, natural remission etc.

    How does your proposed study get around this? Or is this a ‘feature’?

    • Dr. Kaplan February 21, 2012 at 7:15 pm

      I am no researcher but I do know that prospective studies are indeed viable ways of assessing a therapeutic intervention. The factors you mention are obviously important too. I have little doubt, however, that patients seeing a classically trained homeopathic doctor would do much better than patients receiving standard counselling or regular supportive talks by a GP. Double blind RCT do not suit whole person medical approaches and they are not the only way to assess efficacy of a therapeutic approach. Bayesian statistical analysis is probably more suited to it.

  6. Andy Lewis February 22, 2012 at 2:59 am

    An RCT is just a form of prospective study where participants are blinded, thus reducing risk of bias and artifact. So, it would be interesting to understand why you think one sort of prospective study is not possible whilst another (unmentiond) might be.

    Of course, any Bayesian analysis of a trial of homeopathy would rule out the possibility of doing the experiment because no prior probability can be assigned. You cannot assign probabilities to the unphysical.

    • Dr. Kaplan February 22, 2012 at 10:26 am

      Trial design is not my area. I am told a long term prospective study can be done but doing it over many years (as I’ve suggested) may have ethical issues with regard to using placebo on patients who are suffering. As I’ve said my angle is political not chemical. It doesn’t matter HOW homeopathy works. Even if many think its the placebo effect, if the doctors using it on the NHS don’t think that, and doctors and patients see results – that’s enough to keep it on the NHS for me. Patient satisfaction is all important to me and in this regard homeopathy scores highly. It must be simply amazing to you that a hospital that apparently uses placebo exclusively can get such good results. Instead of a nasty attack on NHS homeopathy, you and other detractors and denialists of homeopathy should call for a careful study of this fascinating process

    • Sastry.M February 23, 2012 at 9:09 am

      I think that the Swiss backing of Homeopathy as well as the results of survey are genuine.The commercial symbol of Nestle depicts both the nest and its contents and so do the Swiss with the spirit of Banking and holdings without ever seeking bailouts. Let their cuckoo clocks herald the spring of hope utilizing genuine homeopathic healing rather than democratic revolutions in dust and blood.

    • Andy Lewis February 23, 2012 at 6:20 pm

      One cannot really top that. Cuckoo clocks and homeopathy for ever.

    • Amit Habbu February 24, 2012 at 2:30 pm

      Brian, to my mind RCT’s are possible. In fact one could design a trial for a condition, say migraine, where one only includes those cases who have had a sub optimal response to conventional treatment. And then randomize them to two arms — placebo versus individualized homeopathy. Even if the study is for a long duration there should not be a problem for ethical approval etc. If it is found that one arm is clearly doing better at an interval data analysis cross over will certainly be possible. Such a design is even tougher for homeopathy because although the comparator arm is placebo, the population selected are the non responders to conventional treatment. Though as a design this is a much more stringent examination of homeopathic efficacy, i think this should be doable, as these are the patients we see regularly in daily practice and are seen to improve.

      I think the more important issues are the logistics and funding. Such a trial will certainly need active participation from conventional specialists to lend authenticity.

    • Andy Lewis February 25, 2012 at 1:09 pm

      It would be interesting to see what arguments we get as to why such a trial would not be a fair test of homeopathy.

      Let’s see your best shot.

      • Dr. Kaplan February 25, 2012 at 3:34 pm

        No there is no reason – other than Amit’s very important last paragraph. My preference, however, is for a prospective study because as I’ve said umpteen times, it doesn’t matter how homeopathy works, only that it works. My position on this subject is that of a clinician, libertarian and democrat. I have some views on trials as I’ve said but this is not my field of expertise.

    • Andy Lewis February 25, 2012 at 8:49 pm

      Logistic and funding are requirements for all trials – not just homeopathic ones.

      RCT’s do not shed any light on how homeopathy works. They are merely the best method of showing that there is a causal effect – that homeopathy does work. Prospective trials can never show that.

      I thought you argued “double blind RCT do not suit whole person medical approach”.

      So, are you happy to be contradicting yourself here?

    • Dr. Kaplan February 26, 2012 at 2:29 am

      Not at all Andy. Allow me to clarify and give consequent suggestions of trials:

      1. On logistics and funding: Agreed. All convincing trials require these and funding of convincing trials involving lots of doctors’ and statistitians’ hours don’t come cheap – not even for multinational pharmaceutical companies.

      2, On RCTs: Yes it’s possible to design a good one to test whole person medical homeopathy and this would mean discarding a lot of previous ones. We should have new ones on which all parties agree – from the start. That’s not so hard but providing the money often is – unless you are a mulit-national pharmaceutical company of course. They might correctly (imo) see it as ‘not in their interest’ to fund such trials of homeopathy – even though others might think it was! A combined analysis of these trials could comprise a ‘prospective and pre-determined metanalytic trial’ that could shed light on whether there is an active ingredient in homeopathic pills – or not. Yes, that’s important but it is by no means the only important thing that really, really needs to be found out about homeopathic NHS clinics.

      3. Prospective trials based on outcome are also vital. Instead of purporting to decide if the results obtained by homeopaths going through structured and focused homeopathic interviews with a patients, are no better if the final pill is placebo or active, they attempt to establish whether there has been clinical benefit to significant numberss of patients going through the process – however the process works. That process necessarily requires that the homeopathic doctors utterly believe in the active ingredient because if they did not, it would certainly change the detailed structure of the homeopathic interview. These prospective trials would simply look at benefits say a month, a year, 2 years, 5 years ,10 years after first attendance at a homeopathic clinic (that should sort out the ‘regression to the norm’ argument) and compare them to a control group at a similar clinic treating similar patients with chronic problems – even with conventional medicine. Irritable bowel syndrome would inter alia be a suitable chronic problem to treat but you would still need a structured interview for each patient, – not one medicine for one disease. That’s not how classical homeopathy is done – as anyone who knows anything about it is obviously aware.

      More humane sceptics should support all 3 because even if they believe (and I don’t) homeopathy is pure placebo, positive long-term outcomes in such trials would give us the chance to assess something that is most fashionable in medicine right now – the placebo effect. This in itself is a good reason for Governments to retain its homeopathic clinics. Kudos to them (and incidentally the previous Labour administration) for standing firm on this and protecting the views of a sizeable minority of British people who would want homeopathy for themselves on the NHS and another perhaps even more sizeable minority who would choose to vote for that very British quality of tolerance of the views of others rather than undemocratic attempts to blunderbust authoritarian legislation against NHS homeopathy in parliament – instead of simply asking the people. A few well put-together YouGov polls would show the numbers of these minorities. I found it amusing to see that one or two of our anti-homeopathic celebrities championed the YES vote in the recent ridiculous referendum on ‘partial AV’ or something. They must have been surprised to discover just how many of the British people were utterly unconvinced by them. As far as democracy is concerned anyway

    • Andy Lewis February 26, 2012 at 1:45 pm

      That’s a lot of words to try to disguise the fact that you have contradicted yourself.

      The only objection you appear to come up with against RCTs is that they may take some effort and money. Money need not always be an issue – quite obviously – many homeopaths have already run RCTs of homeopathy. And if money was an issue, of course there are homeopathic companies, like Boiron, who make quite a lot of money and funnel virtually nothing back into research.

      You are also not being straight in acknowledging that RCTs are also a form of prospective study that measure clinical outcomes. You write as if they do not. What you appear to argue for is to do a prospective study without blinding and controls, and instead of admitting this, you try to frame it as a trial that is looking at actual outcomes. RCTs do this too. But in way that is far less likely to mislead.

      Do you understand this vital point?

      I ask this because I find homeopaths tend to bang on with the same arguments long after errors have been pointed out.

      • Dr. Kaplan February 26, 2012 at 3:00 pm

        I am not ‘against RCTs’. I think I made it perfectly clear (if not succinctly) that I favour high quality RCTs and prospective outcome studies. The new RCTs need collaboration of homeopaths and conventional doctors to prevent arguments about ‘cherry picking’ when it comes to choosing trials for meta-analyses. Prospective OUTCOME trials test the homeopathic process however it works which makes them have a different objective from RCTs which I am certainly not ‘against’. Do you understand this vital point, Andy ?

        I have said enough about medical trials. My concern is with the politics – as you know. No matter what the trials showed, I would still defer to the democratic process to decide whether homeopathy were to remain part of the NHS. My position on this has been clear for years.

    • Andy Lewis February 26, 2012 at 4:32 pm

      Dr Kaplan. I only push this as you contradict yourself, but will not say so. You said “double blind RCT do not suit whole person medical approach”. You now say “Yes it’s possible to design a good one to test whole person medical homeopathy”.

      You have not explained how you square these two apparently contradictory statements.

      Then, you keep claiming that “Prospective OUTCOME trials test the homeopathic process however it works which makes them have a different objective from RCTs which I am certainly not ‘against’.”

      But you have failed to grasp that an RCT is just a particular form of prospective OUTCOME trial. It just has better controls than simple prospective studies.

      You also appear to be under the misunderstanding that somehow RCTs test how a treatment works. Surely, you cannot seriously think that – but you keep implying so.

      This is beginning to look like a willful refusal to acknowledge your misunderstandings.

      If I am wrong, then please state clearly how I am missing ‘this vital point’. Just what is your point? What are the different objectives of an RCT and whatever sort of trial you imagine?

      • Dr. Kaplan February 26, 2012 at 4:49 pm

        I’ve said many times that I’m not interested in being dragged into this discussion about trials and that my position is political. Still for the sake of clarification:

        1. I think that outcome studies are more important than double blind RCTs to test the effect of the homeopathic process.*
        2. RCTs are not ideal to test homeopathy because they do not test the homeopathic process. They seek to separate the homeopathic consultation from the pills which is fair enough but does not test the homeopathic process. EVEN IF it were just the consultation (which I don’t think it is) it would still be a fascinating process to study. The last thing you would want to do is ban it. This is the point that you and the Disciples of Scientism do not get and do not want to get.

        *The reason for this is that it does not matter how homeopathy works imo – only that it works. GPs who refer patients to homeopathic clinics are aware of this. As long as difficult-to-treat patients are happy – that’s all that matters and QED.

    • Andy Lewis February 26, 2012 at 5:59 pm

      I find such answers disingenuous as an RCT would answer a very profound question: does the homeopathic ritual of remedy selection have any bearing on outcomes?

      Surely, that is a most profound question?

      If it turns out that it does not, then indeed the consultation may have an effect.

      However, you are now in a very different ball park. One that homeopaths will never let go of. That is why you do not want to test the action of remedy selection – because you would then rapidly become just a weird sort of talking therapy. This may have effects, but then the scope of your practice would have to narrow considerably.

      If it turned out (as I surely believe) that the remedy selection has no effect – and as you insist – the practitioner has to believe in the process – then by definition you are dealing with incompetent practitioners who cannot understand the scope of what they do.

      That strikes me as a very good reason to ban homeopathy.

      • Dr. Kaplan February 26, 2012 at 7:14 pm

        Sorry Andy, but I disagree with so much of what you say in that comment that I cannot go through it point by point. The homeopathic consultation is a profound process that you should actually witness one day. It’s something between a good general practice check up and a psychotherapy assessment. Of course it has an ‘effect’. But so do the remedies in my opinion.
        I’ve given my reasons why homeopathy should remain on the NHS many times. ‘Understand the “scope” of what they do’.? I do not even know what that means.

        As I’ve said: The people are entitled to homeopathy, Christian Democracy, The Wizard Party of Magic and the Monster Raving Loony Party – if such systems are democratically elected. Disciples of Scientism should form their own party, The Party of Scientism (I nominate Evan Harris as leader) and see how they do in the democratic system. Scientism is certainly at odds with modern Western democracy. That’s your problem Andy – not homeopathy and the tiny percentage of NHS funds spent on it.

    • Amit Habbu February 26, 2012 at 6:27 pm

      Andy,

      I am a conventional medicine doctor with homeopathic training and qualification practising in India. Probably i am not in the best position to understand the NHS aspect of the discussion. Though i must say i can subscribe to Brian’s point of view about why it is logical for homeopathy to continue on the NHS. Why not have the same yardstick for all treatments ?

      Can i ask you if RCT’s are the only “evidence” that will convince you if a treatment is effective ?

      • Dr. Kaplan February 26, 2012 at 6:54 pm

        Exactly Amit! People like Andy do not call for one level of EBM to qualify for NHS inclusion. They are selectively biased against homeopathy because it is an affront to their
        scientismic view of everything.

    • Lou bell February 26, 2012 at 6:42 pm

      Hmmm…
      1. An RCT IS an outcome study.
      2. You could do one to include testing of the diagnostic process as part of the treatment

      *of course it matters which parts of the treatment produce an effect. If the consultation is responsible for people feeling better, without needing any homeopathic medication, you could probably get the same effect for half the time, money and effort – or treat twice as many people. If that’s not important, then I don’t know what is!

      Also if it is only the consultation that produces an effect then why not add in a homeopathic style consultation (in depth and with AND offer scientifically proven drugs only.

      The problem with saying the placebo effect is still an effect or all that matters is that patients are happy, is that the placebo effect can itself can sometimes be overstated.

      some of the effects put down to placebo effect could be
      – people just getting better who would have got better no matter what, even without a placebo.

      -people not feeling better but answering questions in a way they think they should because they are grateful for someone trying to help them.

      -people feeling the same symptoms as they did before but recategorising the symptoms to be due to normal things such as tiredness and colds instead of the long-term chronic condition they have and then thinking that the chronic condition has got better.

      Patients still die younger/underlying disease is the same but “patient is happy” – that’s all that matters? So giving out antibiotics to people with flu should be on NHS because it would keep a lot of patients? Even though this is clearly not a good thing for the patient, or society as a whole as we increase drug resistance of bacteria?

      • Dr. Kaplan February 26, 2012 at 6:56 pm

        I refer you to my comments about one level of EBM for all interventions on the NHS. “Also if it is only the consultation that produces an effect then why not add in a homeopathic style consultation (in depth and with AND offer scientifically proven drugs only.” I did not say it was ‘only the consultation’ and it’s not possible to do a ‘homeopathic style consultation’ if you don’t believe homeopathic remedies have an effect – which is what I do believe.

    • David Colquhoun February 26, 2012 at 6:51 pm

      First, congratulations to Dr Kaplan for posting comments from critics as well as supporters.

      Second, may I suggest that you look at a post which has nothing to do with homeopathy, but which does, I hope, make it clear why RCTs are much more reliable than prospective studies http://www.dcscience.net/?p=1435

      I notice that your colleague, Dr Lewith, who prescribes homeopathic pills, has recently published a paper that says the pills don’t work, and it’s all in the consultation. Aren’t you just a bit curious about this question? It seems to me to be quite important to know.

      • Dr. Kaplan February 26, 2012 at 7:05 pm

        I absolutely believe in freedom of speech.

        I am curious about double blind RCT trials. I am also interested in ‘the placebo effect’ and self-induced healing. Most of all I am interested in liberty and democracy as I am sure you well know. Critics of homeopathy are entitled to say what they want but only the people should decide if homeopathy remains on the NHS. So far the Government has protected the significant minority who want homeopathy and the other significant minority who want tolerance of the views of minorities.

        I prefer outcome studies because outcomes are important to patients. Do NHS homeopathic hospitals serve the public however homeopathy works? That is the question that I am particularly interested in and any study you do wrt that will be answered with a resounding YES. That is why homeopathy should remain on the NHS.

    • David Colquhoun February 26, 2012 at 7:56 pm

      Dr Kaplan
      You say

      “I prefer outcome studies because outcomes are important to patients.”

      Are you really quite sure that the reason you prefer outcome studies isn’t just because they are the only sort of study that appear to favour homeopathy?

      • Dr. Kaplan February 26, 2012 at 9:27 pm

        Surely the outcome of a therapeutic intervention is paramount? A GP sending patients to a homeopathic NHS clinic might have private doubts about the efficacy of the medicines the patients receive but be more than happy to send patients there because the outcome of previous referrals for the same type of therapeutic intervention has been very positive in his experience.

        The bottom line is whether patients are benefited. Perhaps I am biased towards outcomes and patient satisfaction because I am a clinician rather than a researcher or political activist. I don’t care how a patient gets better only that s/he gets better and stays better. That’s why I favour long term outcome studies.

        Bottom Line: Benefit to patients is everything. Science is important but only part of clinical medicine. Medicine must be informed by science but never governed by it.

    • Amit Habbu February 27, 2012 at 7:42 am

      David,

      Do you consider RCT’s as the only valid evidence that convinces about efficacy of a treatment for a disease/condition ?

    • Andy Lewis February 27, 2012 at 12:17 pm

      Amit – I am all in favour of a single standard for all treatments. At the moment, it is homeopathy that exists outside of that single standard of evidence based medicine. In the UK we have a body called NICE that reviews evidence for treatments on the NHS. So far, homeopathy has not been subjected to this stringent test. It would not pass.

      Dr Kaplan – you will not acknowledge that outcome studies cannot show causality. Is causality important to you. Patients may indeed get better in an outcome study. Surely it is important to understand if the treatment had any role in that improvement?

      And once again. To the point of boredom. RCTs also measure outcomes. I am beginning to think you are willfully the distorting argument now as this simple point will not go in.

      • Dr. Kaplan February 27, 2012 at 12:44 pm

        Andy, I can assure you that I am just as puzzled as to why you are not hearing me on these issues.

        1. ‘a single standard for all treatments’: Please let me the relationship of this ‘single standard’ to the BMJ pie of commonly used treatment as illustrated by my Pie Man here.

        2. ‘stringent test’: please let me know the exact protocols of this stringent test and a list of safe therapeutic interventions that have been excluded because they have not ‘passed’ it. How did SSRI antidepressants (budget £232m to NHS as compared to homeopathy’s £10 annual budget) do in this ‘test’ ?

        3. ‘if the treatment had any role’. As a doctor I include the consultation, and everything that the doctors says and does in ‘the treatment’. This is why I like outcome studies which will establish whether ‘the treatment’ (in my book) has had a clinical effect. Of course causality is important and RCTs can help us understand the relative roles of the medicine (‘if any’ you -but not I -might say) and consultation play. That is why we need both imo. I understand that this might be difficult for minds set in a rigid Cartesian, deterministic, mechanistic and scientismic vice, to grasp. However that is no reason to accuse me of wilfully distorting anything. Imo it is you who doesn’t get my simple points on homeopathy, democracy and liberty and will not own up to an incredibly authoritarian and somewhat patronising and condescending view that you know better than people’s GPs whether they should be referred to an NHS clinic or not. That’s my point, you know this well but you do not address it.

    • Andy Lewis February 27, 2012 at 1:29 pm

      We have had these discussions before and I have fully addressed the issues regarding the BMJ

      http://drkaplan.co.uk/2011/09/homeopathy/homeopathy-politics-and-liberty/

      and about your obsession with allocating healthcare in what you call a ‘democratic’ fashion.

      http://drkaplan.co.uk/2010/08/homeopathy/nhs-homeopathy-the-aftermath-and-the-whingeing/

      And I am glad you think causality is important. Without causality, doctors just become observers and entertainers. You wouldn’t want to be called that, would you?

      • Dr. Kaplan February 27, 2012 at 6:11 pm

        Re: ‘fully addressed’ You gave your point of view and I gave mine. Yours is authoritarian and mine is libertarian. That’s fine. This post is about something that happened in Switzerland, not about RCTs and trials.

        Re: ‘obsession with…’ yes, I am a bit obsessed with protecting liberty and democracy from slow but inexorable erosion. The price of liberty is eternal vigilance as Thomas Jefferson correctly pointed out. The ‘I know better than you what’s good for you’ authoritarian health lobby is distasteful to all libertarians, not just homeopathic doctors. That’s why many British people would support having homeopathy on the NHS even if they don’t want it for themselves.

        Re: ‘causality’ Yes of course I agree causes are important as is teleology and epistemology. But I think I know a little more than you about whole person medicine. I pointed out to you before that understanding this requires a bit of philosophy and pointed out the work of Karl Jaspers and my teacher Eric Lederman, a medical philosopher. But you saw no need to study the ethos of whole person medicine. Mechanistic and deterministic medicine is enough for you – but fortunately you do not have to help any patients.

        And yes entertainment by doctors can be a good thing. Here is an example of a doctor/wannabe comedian. He is not my sort of doctor or my sort of comedian but I thought he might be your taste.

    • Andy Lewis February 27, 2012 at 7:27 pm

      Have you read the Swiss Report?

    • Andy Lewis February 27, 2012 at 8:29 pm

      Oh, and yes, I have not read your philosophers on ‘whole person medicine’. Neither have I studied the biology and ecology of unicorns. You would not deny me an opinion on their existence though would you?

      • Dr. Kaplan February 27, 2012 at 9:32 pm

        Thanks for that comment because it explains a lot about how you think and who you are. So you are in no need of Kantian epistemology or Husserl’s phenomenology or Jasper’s existentialism as applied to medicine or Smuts’s Holism as applied to medicine. All clearly Unicornism in your book. You know what you know and that’s good enough for you. Congratulations. Not sure why we are even having this discussion on medicine anymore because we are not even on the same playing field.

        As far as politics, medicine and the NHS are concerned, we are on the same playing field but my views are libertarian and yours are authoritarian in that you would have homeopathy centrally banned rather than trust our GPs to make sensible decisions about their own patients and whether they wish to refer them to fully medically qualified and ACCOUNTABLE medical doctors who happen to incorporate homeopathy into their work. That is the area on which we can at least agree to disagree.

    • Amit Habbu February 27, 2012 at 8:48 pm

      Andy, although they certainly have their merits, RCT’s have several inherent problems — like those of cost, time, pro sponsor bias/results, and so on. From a homeopathic perspective one other specific problem is that an RCT’s evaluation of a problem is often too focused to be ideally suitable to a whole person medicine that homeopathy is.

      Meanwhile, what are your thoughts on the kind of diseases/pathologies that placebos could help ?

    • Andy Lewis February 28, 2012 at 9:55 am

      Brian – you ignored my very important question. I shall repeat it.

      Have you read the Swiss Report?

      • Dr. Kaplan February 28, 2012 at 12:29 pm

        I have read enough of it here to give me a pretty clear idea of what it says and recommends. I am actually a clinician not a full time activist so I do tend to read summaries and abstracts when it comes to non-clinical material such as this. Here is a nice extract for you. Perhaps this is one thing on which we can agree. Ours is indeed a ‘dialogue of the deaf’. Emboldment of text is mine and the text can be seen online at the address I’ve given above.

        “Various definitions of complementary and alternative medicine have been proposed. Homeopathy is unique among CAM therapies in originating in European Enlightenment thought. It is controversial and scientifically implausible yet popular, widespread and durable. The result has been a longstanding ‘dialogue of the deaf’, with little progress or genuine discussion. Clinical collaboration and serious and scientific discourse concerning homeopathy is possible and should be pursued. The alternative is not that homeopathy disappears but that it is absorbed into a disaffected medical counterculture with adverse consequences, particularly for patients. The Royal London Homoeopathic Hospital is developing clinical integration and scientific collaboration with a major academic medical centre in London.’

    • Andy Lewis February 28, 2012 at 12:29 pm

      Amit.

      Can you be precise about what you mean when you say an RCT “is often too focused to be ideally suitable to a whole person medicine that homeopathy is.”

      Can you give an example?

      • Dr. Kaplan February 28, 2012 at 12:51 pm

        This is the last thing I am going to write about RCTs and other trials as I do feel our conversation about medicine is indeed a ‘dialogue of the deaf’ as coined in the Swiss Report.

        Whole person medicine (you can read a lot more highly erudite stuff about it here – but probably it’s all Unicornism to you) Is not just about pills and surgical interventions. In whole person medicine the treatment comprises the consultation, the quality of communication between patient and doctor and of course the treatment. However the quality (empathy, authenticity and unconditional positive regard) of the consultation is very much dependent on the holistic treatment model too and cannot simply be parroted or aped by practitioners straitjacketed into a mechanistic and deterministic view of medicine. This is very important and illustrates my point that we need RCTs AND prospective outcome trials.

        RCTs: to determine the exact roll of the pills in homeopathic process. Important but not as important as the next point.

        Prospective Outcome Trials: to determine the effect of homeopathic treatment on people, short, medium, long and very long term. VERY important because as you know, I don’t care HOW homeopathy works, only that it works.

        Now you are welcome to question what I have said here, but I am not going to write anymore on this. The Swiss Report is about medical politics as was this blog and somehow the thread has been lost. My main contribution to this debate is to defend liberty and democracy regarding medical matters and feel that I have a very, very strong case. As far as ALL trials are concerned I still say that:
        Medicine should be informed by science but never governed or tyranised by it. Doctors should always be accountable for their actions but never become robotic foot soldiers of authoritarian ‘I know better than you what’s good for you’ disciples of Scientism who seek to force their views on the people rather than consult the people, present them with their views and ask them what they want.

        As Churchill said: ‘The best argument against democracy is a five minute conversation with the average voter.’ It’s funny and true but nevertheless, democracy is very, very precious and any alternative to it is a thought too horrible to contemplate.

    • Andy Lewis February 28, 2012 at 1:04 pm

      So Brian, you have read a few introductory pages.

      I have read it. It was tough going. I ask because the report spends a whole chapter on RCTs. You said your post was not about RCTs, but they are central to Bornhöft and Matthiessen in their report. They spend a lot of time trying to convince their readers with a lot of handwaving about how RCTs may not be reliable. They then go on to strum though rather uncritically various RCTs and reviews.

      We may well be involved in a dialogue of the deaf. But that does not mean that both of us are deaf.

      • Dr. Kaplan February 28, 2012 at 1:50 pm

        No it doesn’t but I certainly feel unheard wrt:
        1. The philosophical basis of Whole Person Medicine.
        2. My main points about authoritarianism in medicine, democracy and liberty.
        3. My contention that much of NHS orthodox medicine is far from evidence based.
        4. The attack on homeopathy exclusively – instead of deciding on a level playing field and stating categorically the evidence required for the inclusion of ANY intervention on the NHS.

    • Andy Lewis February 28, 2012 at 2:18 pm

      To answer your numbered points.

      1) ‘Whole person medicine’ comes across as an excuse, not a rationale. I have asked Amit above to give an example of how ‘Whole person medicine’ affects RCTs. Would you care to give your answer? I am all ears.

      2) We have been through this. Your simple ideas about ‘democracy’ quickly start creaking when the roles of the physician and informed consent start being taken into account, for example. There is nothing authoritarian about expecting patients to be informed of the nature of homeopathy. And there is nothing authoritarian about expecting doctors to practice according to good science and best evidence.

      3) It has been explained to you countless times why your obsession with one graph is misleading. To repeat: this as nothing to do with the frequency of evidence based interventions – which have been estimated to be much higher than a mere tally of possible treatments. Listening? And, in any case, this argument of course does not justify homeopathy being unevidenced.

      4) You write about homeopathy. You are a homeopath. If people are critical of your approach, why do you expect them to talk about other things?

      You have been heard. There are responses. There always have been. Do you want to take them on board?

    • Andy Lewis February 28, 2012 at 2:28 pm

      I have now read your post on ‘whole person medicine’.

      Lots of assertions and some obvious mistakes.

      Why is it that mainstream medical practices cannot take into account “empathy, authenticity and unconditional positive regard”. What is it about giving a homeopathic sugar pill that mediates these qualities?

      Can a homeopathic practitioner be ‘authentic’ if the treatments are placebos?

      A point you keep failing to take on board is that your uncontrolled prospective outcome trials cannot tell you about the efficacy of the intervention. They might tell you about the collective history of a cohort of patients. But that is about it.

      I fear you do not want to talk about this any more because your argument collapses as soon as you engage with this point – which you have obviously tried very hard to avoid.

      • Dr. Kaplan February 28, 2012 at 2:35 pm

        Indeed there have been responses but they have not won the argument. In fact when the argument was presented to two governments, they took my side. Let’s leave it at that

      • Dr. Kaplan February 28, 2012 at 2:40 pm

        No I don’t want to talk about this anymore because you and I have reached the end of any useful discourse on this issue. You do not ‘get’ homeopathy which, far from ‘sugar pills’ (and I don’t believe homeopathic remedies are placebos) is a structured process of empathic dialogue followed by a prescription based on a very clear understanding of the dialogue and the purpose of the dialogue. If this process gets results that is good enough for me – but not for you. Let’s leave it at that okay? There is a limit to how much we can achieve in this dialogue on my blog. However if you want to take me on in a public debate, just set it up and I will be there. On the beaches or in my own backyard.

    • David Eyles February 28, 2012 at 3:49 pm

      Brian,

      I think you have expended patience, good humour and impeccable good manners in the face of unremitting obsessive/compulsive off topic comments and obduracy far beyond the call of duty. Andy is wasting your time and the point of your blog. It’s your blog – don’t let him take control of it

      Personally, if you happened to be in a didactic mood, I would welcome a thread from you as to the philosophy of science which has developed you thinking over the years, and how you think this has enhanced your treatment of the patient

      • Dr. Kaplan February 28, 2012 at 3:58 pm

        Thanks David,

        Have a look at the site of my late mentor, Dr E.K. Ledermann, a doctor and medical philosopher. Thanks for the suggestion. I will write about how his medical philosophy informs my treatment of patients with both physical and psychological problems. His site was made some time ago and abandoned since his death in 2005. A quick read is my obituary of him which was published in The Times. More on his site and in his classic book, Philosophy and Medicine.

    • Andrew Sikorski February 29, 2012 at 4:38 pm

      Andy lewis’ sole voice with a minor supporting role from Dave is a reflection of how few people are botheresd by what they obviously feel is an elephantine issue, unlike waste in the NHS providing unproven ‘scientific’ treatments. Good to know they can sound off here in preference to bottling up their sentiments – which is what they would appear to want anyone disagreeing with them to do.

      • Dr. Kaplan February 29, 2012 at 6:57 pm

        @Andrew Sikorski: I agree though Dave certainly cannot be said to ‘support’ Andy in any way, but maybe that’s what you mean. Two or three other commentators too.

        Re: Andy Lewis: I didn’t mind thrashing some of these things out with Andy. Unlike some of the other detractors of homeopathy, he is generally courteous and most of the time refrains from making ad hominem attacks. This I don’t mind as it helps me hone my own views and examine the ethos of my practice.

    • Andy Lewis February 29, 2012 at 6:46 pm

      Andrew – it could also just be a reflection of the unimportant of this blog.

      I come here for research. You are my experiment. My words are a stick. Your beliefs are a cage.

      • Dr. Kaplan February 29, 2012 at 11:25 pm

        @Andy Lewis: Somewhat predictably, I riposte that it is you who are caged by your deterministic and mechanistic views (best summed up by ‘I know better than you what’s good for you – medicine’). Given half a chance you would impose these views on the people whether they like it or not. The real issue is authoritarianism vs. libertarianism. You have clearly been aware of my position for some time. QED

    • Amit Habbu March 1, 2012 at 2:01 am

      Andy, you could google disadvantages/limitations of RCT’s and you will find these drawbacks such as narrowness of the outcome being studied etc.

      But you didn’t reply about your thoughts on potential placebo responsive pathologies. Or do you think any pathology can be cured by placebo ?

    • Andy Lewis March 1, 2012 at 4:53 pm

      Amit, Dr. Kaplan

      If a group of people came to homeopaths all with symptoms of, say, hayfever, what outcome measures would a ‘whole person medicine’ practitioner choose that a conventional doctor would not. And what is it about the RCT that prevents you including that outcome measure?

      • Dr. Kaplan March 1, 2012 at 5:25 pm

        Amit you are welcome to answer Andy but as I’ve said I’m done with discussing RCTs with him.

    • Amit Habbu March 2, 2012 at 2:19 am

      Andy, even in my first comment on this post i have said that it is certainly possible to do RCT’s using homeopathy as the treatment arm. Say you have a trial design where the primary end point is to see the impact of treatment on hay fever at 6 months. There will be occasions when the patient as a whole ( say for incidental pre existing symptoms of anxiety, depression, bronchitis, irritable bowel etc ) may be better than before however hay fever may be unchanged at 6 months. It becomes difficult for a trial empowered statistically to study hay fever results at 6 months to make pertinent comments on these other situations the patient may have. This outcome from a homeopathic perspective indicates that the more important problems a hay fever patient was having are better and that it is only a matter of time ( with homeopathic treatment ) before the specific symptoms of hay fever also improve. However the trial design may at six months not give a positive result even though a statistically significant number are generally better. It is difficult to match two groups of subject identically from a homeopathic perspective, although from a conventional point of view we do this all the time.

      But a good RCT is possible to execute in homeopathy.

      What are your thoughts on placebo responsive states ?

    • Andy Lewis March 2, 2012 at 9:04 am

      Brian – I ask a simple question that tests the issues around trials and ‘whole person medicine’. It should be simple to answer if your assertions have merit. You do not answer. I draw my own conclusions.

      Amit – thank you for responding, but I do not see an answer.

      Can I be clear? I am asking what outcomes would you want to count in ‘whole person medicine’? Would they be different from conventional approaches? What difficulties would your outcome measures pose for an RCT.

      I don’t see these as difficult questions. Brian talks about the importance of outcomes. So what do you think the outcomes should be for people who come to you with hayfever?

    • Amit Habbu March 3, 2012 at 5:40 am

      Andy, per se there are no difficulties.

      You have refrained from commenting on placebo responsive conditions.

    • Sastry.M March 3, 2012 at 4:55 pm

      In my opinion there are two ways of looking at the world. One is like a frog in a well, looking up at the rounded opening above and surmising the extent in contentment. The second is to hold a comb before eyes and gaze at the world through serrated slots in between teeth and integrate the bits of view into a panoramic picture.
      The former view corresponds to the Indian (Oriental) and the latter to the Hellenic (Western). In either case there is a faculty of human mind-consciousness which can split up any view into much smaller bits and pieces to analyze the subtler causes to any degree of accuracy and comprehend the overall effect for the best possible definition in a rational manner.
      The Indian view represents and seeks to recognize a holographic completeness of any phenomenon. The western intellect sees any phenomenon presented in bits and pieces under natural observation, and seeks to analyze finer/subtler causative aspects individually, and finally integrate “within observable and definable” limits of both sensory body and subtle mind comprehension into a rational scientific definition.
      The Indian Yogic practices are devised to increase the range of subtle mind consciousness extending from within the precincts of one’s own body field out into the external world to realize direct integration.
      The Western practices seek to extend the subtle mind-conscientiousness through support of augmenting scientific instrumentation to those of own sensory body and to realize a rational and integrated Phenomenal definition.
      Both the analytical and integrated approaches assigned to Homeopathic philosophy and methods of therapeutic practice fall readily to Indian view and hence implicitly retained.
      It was a German,a western physician who possessed the most refined and sensitive mind consciousness that readily integrated to his contemporary Time spirit(Zeitgeist)and inspired to recognize a buried concept from an age of enlightenment to bring in service to aid the medical needs of modern scientific age.

      • Dr. Kaplan March 3, 2012 at 8:34 pm

        @ Sastry, M Thank you for that. Indeed our Western thinking is deeply imbedded into dualism and it’s hard for determinists and mechanists even to understand what you are saying. A yogi once said: ‘Western mind, Eastern mind – never mind the difference!’ However in the transcripts of the discourses of J.Krishnamurti we hear the voice of man deeply influenced by the best of both East and West. And, yes, I happen to know that he was successfully treated with homeopathy by George Vithoulkas. Andy could do well to read Krishnamurti on any subject. Here is a clip of him talking to a famous physicist:

    • Andy Lewis March 3, 2012 at 6:12 pm

      Placebo responsive states? Great. Love them. Pain and mood might be placebo responsive. So what?

      But Amit just like Dr Kaplan you contradict yourself as soon as you are questioned about RCTs.

      You said “an RCT’s evaluation of a problem is often too focused to be ideally suitable to a whole person medicine that homeopathy is.”

      You cannot give an example of what outcomes you might look for in ‘whole person medicine’ and why these outcomes cannot be subject to an RCT.

      I think Brian knows the answer to this one. That is why he declines to take part.

      The answer I think that is lurking is that outcomes in ‘whole person medicine’ are too wooly to be defined. They tend to be whatever outcomes happen that suggest an improvement has happened. All post hoc reasoning. For example a patient may come in with hayfever, the number of attacks do not decrease, but maybe you get reports of a mood improvement. Thus you decide ‘whole person medicine’ was focusing on mood.

      Am I wrong?

    • Amit Habbu March 4, 2012 at 2:40 am

      Andy, okay so in your opinion mood and pain may be placebo responsive.

      What about cases like cancer, aplastic anemia, immune thrombocytopenias ?

    • Andy Lewis March 4, 2012 at 8:28 am

      Stephen Law, the philosopher, in his book Believing Bullshit warns us about those with an air of pseudo-profundity.

      Sometimes, when it is difficult to understand someone, it is not because they are profound, it is because they are talking nonsense.

      In order to find out if someone has profound thoughts or is talking nonsense, I ask simple questions.

      When I get diversionary tactics back, I can be sure I am dealing with the latter.

      I ask again, what outcome measures do people dealing with ‘whole person medicine’ look for and why would measuring them be difficult in an RCT?

      • Dr. Kaplan March 4, 2012 at 12:40 pm

        Andy,
        I’m not interested in discussing trials of whole person medicine with you anymore because it is utterly clear to anyone who knows anything about an Holistic approach in medicine that you know next to nothing about the subject and have little intention about learning anything either. (When I referred you to the website of my mentor, EK Ledermann you referred to it as ‘my post’. Clearly you have not read it. (I’ve linked it here again) You are simply not qualified to talk on this subject but could learn more here and here. but I’m pretty sure you will not do this.
        On medical politics we are at least on a level playing field. You are cleary authoritarian and scientismic (‘I know better than you what’s good for you medicine’ presumably because ‘I understand science better than you’.) and I am clearly libertarian and democratic in that I have more trust in the people than you do. This can be discussed but on the ethos, practice and testing of whole person medicine, do not expect me to talk to you about this anymore. You simply do not know enough about clinical medicine and whole person medicine and I have spent enough time trying to give you a rudimentary education in this field.

    • Andy Lewis March 4, 2012 at 1:50 pm

      Dr Kaplan-your position is absurd. You claim I do not want to know about ‘whole person medicine’ but refuse to answer a most basic question.

      You have been arguing for two things: outcome studies to evaluate homeopathy and to take into account the unique characteristics of what you call – whole person medicine – in evaluating trials.

      So, in order to understand what you mean and to see if it has merit, I ask you a very simple question: what outcomes would be important to you and how would this impact on an RCT.

      You could answer in a sentence.

      I understand fully Bayesian analysis. It makes trials of homeopathy near impossible to interpret because the prior probability is effectively zero. I also looked at that sight from the mid 1990’s (by the look of the design). Wishy washy mumbo jumbo. Does not answer the simple question that I pose.

      Will you answer my question? What outcome measure would you use? What is it that is important to you? Please feel free to use my example of a patient who presents themselves wanting relief from hayfever.

      • Dr. Kaplan March 4, 2012 at 2:14 pm

        ‘sight from the mid 1990s’ ?? ‘Wishy washy mumbo jumbo’ ? Now there is intelligent literary criticism.
        As far as answering your question, I refer you to my previous comment which I stand by. But hey we do have something in common! We both think each other’s position is absurd. Let’s leave it at that. The last word is yours (as long as it is not an ad hominem attack) but it will be the last word in this thread. It’s going nowhere and it’s boring now.

    • Andy Lewis March 4, 2012 at 2:43 pm

      Yes. Going nowhere. I have my conclusions now. I was really interested to see if your ideas on the weaknesses of RCTs, the need for outcome studies and ‘whole person medicine’ were coherent and thought through.

      I would have hoped that a few simple questions would either let me see that you had a strong intellectual position or whether such concepts, as I suspect, are mere inoculations against criticism.

      We are indeed done now on this line of thought. I have my answer.

    • tal March 4, 2012 at 6:08 pm

      I’m surprised Dana Ullman provided no background to the Swiss referendum which was filled with precisely the sort of backstage politics we have come to expect from the defenders of scientism.

      See:
      http://smeddum.net/blog/tag/programm-evaluation-komplementarmedizin/

    • David Eyles March 4, 2012 at 7:21 pm

      Andy,

      At the risk of incurring Brian’s wrath by perpetuating a subject he clearly feels is effectively closed, I am surpised to find you stating (twice) that a Bayesian prior is “effectively zero”. As this does not accord with my textbook definition, perhaps you would explain exactly why the prior is zero?

      • Dr. Kaplan March 4, 2012 at 11:20 pm

        ‘wrath’ ? 🙂

    • David Eyles March 5, 2012 at 10:57 am

      Yes, perhaps “wrath” is a little too strong a word for you Brian. It rather conjures up an image of a Dr Kaplan sitting like William Blake’s Newton – crouching naked on a rock, muscled and glowering at his online creation, dividers in hand……. So perhaps if I modify that sentence to: “At the risk of incurring Brian’s raised eyebrows……”

      Incidentally, I thank tal for his/her link. I did not realise the extent of the political interference with the Shang meta-analysis. It would go a long way to explain some of the extraordinary methodological flaws, post hoc analyses, lack of transparency and other difficulties with that paper. There are many things about this paper which have puzzled me for some time, particularly given the eminence of at least some of the authors, and this background has helped me understand.

      • Dr. Kaplan March 5, 2012 at 11:49 am

        Yes indeed. Blake would have been appalled by the Disciples of Scientism. Although I am often attacked for using the word ‘scientism’ I do think I understand its meaning v. well. It is the raising of science to ideology. Almost everything opponents of NHS homeopathy say, is better understood when one realises that these people are ideologues and will use anything to get their ideas foisted on the public whether the public want them or not.

        Motto of the Disciples of Scientism in relationship to Politics, Homeopathy, Evidence and the NHS
        ‘We know better than you what’s good for you!’

        Thus you will never hear of these people calling for market research on what the taxpayer thinks of NHS homeopathy. Instead they try to force their minority (imo) views – in the names of ‘science’, ‘logic’ and of course their favourite word ‘evidence’ on the people – whether the people want it or not. For them this is a political movement pure and simple. They want a system built on their idea of what constitutes ‘evidence’ and what the actual people believe is irrelevant to them. That is why my allegations of them being illiberal and anti-democratic are seldom addressed and they try to draw me into detailed areas of what constitues evidence such as RCTs, prospective studies etc.

        As the true method of knowledge is experiment, the true faculty of knowing must be the faculty which experiences.” (Blake)

    • David Eyles March 5, 2012 at 1:46 pm

      Now, of course, you will be instantly rebuked for “outmoded 18th Century empiricism” for your quotation of Blake.

      Provided I don’t get too carried away and takes things too personally, this whole debate fascinates me because I cannot for the life of me understand why (what is actually a tiny group of people) consider that they have the right to extinguish what is simply another way of acheiving, or aiming for, good health. Furthermore, they feel that they have the right to dictate to the taxpayer, who may wish to receive some sort of CAM on the NHS, that that taxpayer can’t have it simply because it does not fit into the model that this same tiny number of zealots have chosen for us.

      Some of them have been known to argue that proper “informed consent” must be obtained from the patient before being allowed to receive CAM (I think this is one of Ernst’s little suggestions). What they mean is that the patient must be told “You realise that this treatment cannot possibly work, don’t you?”. Actually, if you balanced that against a similar informed consent for the the real risks and dangers of many, if not most, conventional treatments then perhaps it’s not a bad idea. The dangers of long term use of steroids are rarely pointed out to patients. The same goes for such things as second order immunosuppressants such as Cyclosprin. And they really do have nasty side effects, as I know to my personal cost.

      Actually, we are to a large extent giving our informed consent the moment we are setting foot in the surgery waiting room. We are allowing a particular form of intervention that we know that particular clinician uses, to be used upon our bodies. We can only ever hope that whatever that intervention is, it will work. (And all too often it does not).

      All we can hope for is that clinicians will at least be honest in what they are offering us as patients, and that they are equally honest in giving us information as to what the choices are that they personally are not able to offer. That level of knowledge, never mind honesty, is rarely on offer to the average NHS patient, crammed as we are into a seven or eight minute appointment slot.

      • Dr. Kaplan March 6, 2012 at 12:20 am

        Beautifully expressed, David. Thank you.

    • Sastry.M March 5, 2012 at 3:40 pm

      Dr.Brian Kaplan,
      Thanks for your ack’d.comments. The obscurities confronting homeopathy reg.EBM and RCT, in my opinion, cannot be explained with the current western mindset. The Indian philosophy need not be studied and understood in all its entirety but relevant areas helping clarity of thought can be receptively understood.
      Considering the psycho-somatic nature of human diseases acceptable to both classical and homeo schools one can attempt to clarify the apparent inadequacies of the homeo as contested by the accepted classical.
      Consider my opinion expressed as a general statement: “Soma is sensitized and responds to energy stimulus and Psyche cognizes and recognizes physical signatures”.
      Inert physical entities are not self efficient but appear as rationally and definitively programmed by some ‘external agency’ and respond to external forces.
      Quoting ‘psyche’ in whatever way it is understood and applied in the West,in association with physical (somatic) forms makes up living beings with an efficient self directive properties.
      All physical systems incl.the brain of highly evolved living forms lie in the realm of E.M field structures both at atomic level and physical sensory receptive domains.
      The physical body responds to both intensity and repetitive characteristics of impinging sensory stimuli.The min. perceptive threshold and max.bearable sensory stimuli are normally defined, but vary in extreme limits according to individual dispositions.
      Just as electrically operated networks accessing and interfacing various elements in computer operations, consciously activated psyche assigned to autonomous physical(biological)body functions keeps it in proper condition for voluntary user (I conscious psyche or ego)directive operations.
      Now the western mind has to stop for a while and look to east whence light of the Sun begins illuminating the physical world with which it is so much concerned.
      We observe that while physical systems are directly sensitized by intensity of input stimuli, their exhibited response need not bear the same relation to all input characteristics such as electrical filter networks to varying input frequencies. However their rational behaviour can be predicted under similar controlled conditions. The same cannot be attributed to psyche operated life systems.
      Although the body rationally responds to judiciously selected sensory stimuli, the individual responses vary largely according to life systems.Man may meticulously collect all explosive detection information and synthesize the best detection instrument covering all expected probabilities.Yet a statistical improbability (C.G.Jung) lurks unrecognized and calls in for dog squads.Therefore information gathered from direct sensory perceptions or supported with scientific instrumentation cannot comprehensively establish dependable evidence in the case of living systems. -can i continue?

      • Dr. Kaplan March 6, 2012 at 12:24 am

        Yes of course you can continue. You represent ancient Eastern wisdom. And you are right; the exclusively Western ‘mindset’ (terrible word but a Western word) doesn’t get it.

    • Sastry.M March 7, 2012 at 3:49 pm

      With thanks for permission I wish to continue by submitting that by study and training for a diploma in electronic communications engg. during early 60’s I feel truly subjected to the Yogi’s observation. Beginning with electronic tubes as active circuit elements I have retired in 2002 using micro miniature integrated components. Indeed I now feel like a proud ‘brown’ skinned westerner, both due to my profession which helped earn for a living and also widest areas of application in communications as well as all other scientific fields.The real miracle is micro-miniaturization of active elements resulting in small hand held phones as a marvel of 20’th century.
      If I were to be graduated as a classical school physician I would have said: Oh behold homeopathic quackery boasting marvelous cures using infinitesimally dosed medicines with placebo assured confidence.By my profession I do not luckily entertain any professional jealousy but happily admit that whatever the miniscule homeo medicines prescribed I was greatly relieved of a 17y tormented itching rash around groins and waist within 6 months and permanently in 18 months.
      Relevance of interest to me is ‘infinitesimal’ and micro-miniature signatures. The former is a theoretical concept and the latter is a recognizable physical identity. The etched die wafers before encapsulation of any I.C designed for a particular functional performance present exactly similar physical signature. Energizing an I.C with proper electrical bias can only reveal its functional characteristics.
      The infinitesimal concept relates entirely to human mind which forms the basis for Calculus in a variety of mathematical operations. I.C wafers can be inspected under an ordinary microscope and an electron microscope for even much smaller entities of inverse denomination. However,can we set sky as the limit in design perfection of microscopes to enable one to observe infinitesimal particles? Now the point of consideration is that the conscious mind can conceptually set an upper limit such that there will be an infinitesimally small difference prevailing even after a previously set limit is reached….ad infinitum directly above and infinitesimal inversely below.
      My intention in roundabout rhetoric above is to impress upon western mind the very transcendental nature of human mind in setting up arbitrary limits of sarcastic concepts and yet complying to natural laws for scientific revelations. can I dabble further in defense of Homeopathic concepts?

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