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Subject: [Minutus] Patients must be told homeopathic remedies are placebos [1 Attachment]
Recent stuff from our dear friend Ernst.
Soroush
Patients must be told homeopathic remedies are placebos
16 Nov 10
Professor Edzard Ernst looks at the latest in a long line of studies that have come to the same
conclusion over homeopathy
Click here for more from Edzard Ernst
Brien et al recently reported the findings of an RCT aimed at differentiating between the effects of
the homeopathic remedies and the consultation [1]. Their results confirm that homeopathic remedies
are placebos and show that 'the benefits of homeopathy are attributable to the consultation'.
As frequently discussed on this blog, this is the inescapable conclusion of tons of research.
Observational studies demonstrate that the homeopathic encounter can be helpful (for example [2]).
Controlled trials by and large suggest that homeopathic remedies are pure placebos [3]. There is
only one obvious answer: the remedies count for nothing and the encounter does it all.
Brien et al [1] argue that the placebo effect of the consultation with a homeopath is specific to
homeopathy and 'dependant on the ritual of the collaborative and highly individualized consultation
necessary to identify a homeopathic remedy and associated symbolic meaning response for that
patient'. But there is no evidence for that assumption, and I would question whether ineffective
therapies can be vindicated through the non-specific effects they generate. A useless surgical
operation, for instance, does not become useful and recommendable because it generates a host of
non-specific effects which are typical of that setting.
If homeopathic remedies are ineffective and empathetic therapeutic encounters are helpful, as
responsible healthcare professionals, we should discard the ineffective and adopt the helpful. If we
do this, we must tell our patients that homeopathic remedies are placebos. We should be equally
clear that the therapeutic relationship is important. I think (some) GPs could learn a lesson here.
Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School,
University of Exeter
References :
1. Brien S, Lachance L, Prescott P, McDermott C, Lewith G. Homeopathy has clinical benefits in
rheumatoid arthritis patients which are attributable to the consultation process not the homeopathic
remedy. A randomised controlled clinical trial. Rheumatology 2010
2. Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for chronic disease: a 6-year,
university-hospital outpatient observational study. J Altern Complement Med 2005; 11:793-798
3. Ernst E. A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol 2002;
54:577-582
Readers' comments
* Brian Kaplan - London | 16 Nov 10
Interesting. So is Professor Ernst saying that for their own good, those patients
befitting from the 'homeopathic process' - however it works - should be told in no uncertain terms
that science has found that 'it's all in the mind' and they are benefiting from the placebo effect?
So maybe the lesson that 'some' GPs should learn should comprise the following: 1. Patients should
also be told that more than 50% of common orthodox interventions do not have evidence behind them
yet might have unpleasant side effects. (http://clinicalevidence.bmj.com/ceweb/a ... wledge.jsp)
2. Patients on SSRI anti-depressants (esp. including those reporting a clinical improvement) should
be told that a major meta-analysis by Kirsch et al shows that SSRIs are no better than placebo for
mild and moderate depression.
(http://www.plosmedicine.org/article/inf ... ed.0050045) and that the budget for
these drugs alone costs the National Health Service TWENTY TIMES tthe cost the NHS budget for
homeopathic medicines. 3. GPs need to find ways of having more empathetic conversations with their
patients but certainly not 'homeopathic conversations' with the object of prescribing a homeopathic
remedy because that would be dishonest, 'bogus' and 'counterfeit' even if the doctor (in spite of
Shang et al) believes that the homeopathic remedies have a positive clinical effect. Prof Ernst. I
will never repeat the inconvenient studies of Kirsch and the BMJ's Clinical Evidence here again,
because after the comments made by you and Joe Chemist in your last post, I have decided that this
will be my swansong in the comments section of your blog. I wish you, the anonymous Joe Chemist, the
witty and entertaining Andrew Sirkorski and the rest of you, many interesting and illuminating
conversations that will in the final analysis be of benefit to patients consulting medical doctors
in the United Kingdom. Good bye.
* Andrew Sikorski - WADHURST | 16 Nov 10
Dear Edzard The canard in the soup is: no matter how often I tell them its just a
placebo, patients will keep coming back asking for antibiotics for their cough or homeopathy for the
symptoms they have had little benefit with from conventional medicines. It must be that wonderful
research confounder 'PATIENT EXPECTATION BIAS'. People come to their doctor expecting to get better-
There are those, whom every GP knows, who tell the tale of how ill they were UNTIL THEY MADE THE
DOCTOR'S APPOINTMENT. Now, sitting across the consultation table from me, they tell me what a fraud
they feel they are! Therefore there must be an additional' PATIENT ANTICIPATION BIAS'. All we
clinicians can do is either be exceptionally strong and do nothing, which makes both patient and
practitioner feel a bit of a waste of space, or prescribe the most innocuous medicinal product
available- agreed- often amoxicillin -to make both parties feel valued and valuable, and generate a
prescription destined for the waiting room bin, or else to be considered an elixir of...'
placebothappy'(sic). Please offer an opinion on the scientific place of these 2 new biases we have
recently had the pleasure of discovering through the beneficence of the existence of your blog?
* Chris Wright | 16 Nov 10
It really has got to the stage where not only is there no reasonable physical
explanation for homeopathy but almost every high class trial demonstrates that it is only a placebo.
However, unfortunately, cult-like beliefs are not amenable to reason and so you will get the usual
rants from the usual names (Kaplan, Sikorski) defending their belief in the their own supernatural.
It's sad but too true.