The Paradox of the Good Homeopath

A correspondent has made valid points about the quackometer that I should be careful to ensure that it only awards Canards to real quacks. A sentiment I share and I worry about how to achieve this. I was told to make sure I didn’t get the ‘good guys’ who look into the effectiveness of alternative treatments. Fair enough – but this is a murky world, and telling the good guys from the quacks is not necessarily easy. For example, what makes a Good Homeopath? And can I adjust the Quackometer to go easy on them? Let’s explore.

First, an an example. Professor Edzard Ernst of Exeter University in the UK is widely regarded as being fairly unique and well respected in the academic world for his work on the safety and efficacy of complementary medicines. A summary of his department’s work so far shows that, for example, there is no evidence for the effectiveness of homeopathy, reiki and iridology, but evidence for some limited efficacy of acupuncture in nausea and also for massage. His work is well received by the broad scientific community and mainly attracts criticism from those practitioners of alternative medicine who don’t like his results. I am pleased to say that the Quackometer awards Professor Ernst 0 Canards.

Professor Ernst is a pretty rare fish though. The universities in the UK are beginning to fill up with quack academics who do research into alternative medicine and most of them appear to be little more than apologists for quackery. Third rate universities are offering bonkers degrees in homeopathy and the like in order to fill their quotas, get their money from the government and the gullible students, and in doing so add to the air of respectability for this huge multi-million pound con. Poorly reviewed and tame journals are set up to publish miserable pieces of work that could be torn apart by a sixth form student who understands the term ‘randomised, double-blind controlled trial’. (Tip: buy this book – Trisha Greenhalgh’s How to Read a Paper.)

One name that was offered to me was George Lewith and currently scores 6 Canards. Is this a reasonable score? Dr Lewith looks like an interesting character and may well share characteristics with Professor Ernst. He is a part time researcher at the University of Southampton’s Complementary Medicine Research Unit. He has regularly appeared in print and in other media criticising some of the wilder claims of alternative medicine and published papers that show negative (as well as positive) results for alternative medicine experiments.

His main interests appear to be in acupunture and he has trained as an acupuncturist in China. Interestingly, he has tried to develop good ways of doing ‘sham’ acupuncture – the patient believes the needle has penetrated the skin where is in fact the needle is like a stage dagger. It withdraws into a sheath when pressure is applied. This is required in order to attempt blinded trials. How you blind the acupuncturist as well is another matter. Dr Lewith has published results showing that real physiological effects happen when you really stick needles in people. (Am I surprised? No. Does this give credibility to the claims of acupuncturists? Hardly. There is a long way to go from a real physiological response in people when you stick a needle in someone to proving all that stuff about meridians, blocked chi and curing everything from chronic pain and anaesthesia to constipation and drug addiction.)

So, interesting stuff from Dr Lewith. However, what is a little more difficult to get to grips with is that his day job is at a private alternative medicine practice in Southampton. Here a range of alternative medicine is offered to customers, including acupuncture, herbal medicine and homeopathy. Despite, Dr Lewith’s many criticisms of alternative medicine, is he still practicing such techniques as part of his job? Does this mean he deserves his 6 Canards? How do you reconcile him being ‘one of the good guys’ with him just being one more alternative medicine practitioner.

Well, one way would be if he practiced within his extensive knowledge of the evidence for the effectiveness for such treatments. Maybe acupuncture for some nausea prevention and so on. But homeopathy? The best clinical evidence is that is provokes a placebo effect and nothing else. Science tells us it can have no other effect as we have discussed recently. So does a Good Homeopath just use their sugar pills to act as a placebo? Undoubtedly some people will benefit from a long consultation and a placebo. If you are undergoing a prolonged nasty conventional treatment or suffer from some difficult to cure chronic pain, then such treatments may alleviate psychological difficulties and so on. If so, it would be hard to condemn someone working in this way as a quack.

So, how do you tell a Good Homeopath from the quack? Now we are in trouble. The difficulty is that in order for a placebo to work, the patient must really believe that they are getting a treatment that is going to be useful to them. Long consultations, a ‘holistic’ and ‘individualised’, approach, careful prescription of the differently labeled sugar pills, all add to the air of the shamanic ritual that can lead to the hypnotic response of the placebo. So the Good Homeopath has to be a damn good liar to their patient. Any hint that they are just going though some mumbo-jumbo ritual and the deal is off. Herein lies the paradox. The Good Homeopath has to lie through their teeth, treat the patient as if they were just one more credulous sucker and go against all that new-fangled patient-doctor relationship stuff involving informed, consultative decision making that doctors are expected to do these days.

A doctor with a homeopathic practice cannot let slip that they know it is a placebo ever. Dr Lewith has written many times about the effectiveness of homeopathy for various treatments. Is this part of the charade? We cannot tell – that is the paradox. The Good Homeopath has to appear as indistinguishable from your common or garden quack in order for their placebo interventions to work.

My challenge to the Good Homeopath would be this: that in behaving as such, are you not adding to the air of respectability that we find on the pages of the Sunday supplements where such diligence may not be observed? I think that for this reason the Good Homeopath still needs a few quacks on the quackometer.

postscript:

The Good Homeopaths in the UK has received a body blow today and I am surprised they are not making a fuss. New legislation has come in that allows manufacturers of sugar pills to put claims about what they are ‘good for’ without any evidence to their efficacy. Yep, the makers can put their canards on their advertising and labels without any proof of what they say. This is not going to benefit the Good Homeopath who has to go through the long expensive trouble of providing the ‘complex intervention’ of the consultation for the placebo to kick in. Now, someone can just walk into Boots and pick up the ‘right pills’ for them. Big Pharma wins again.

I would be furious if I was a Good Homeopath.