Comment: Homoeopathy, ethics and controversy

Comment to the article “Homeopathy isn’t unethical, it’s just controversial” by Jon Wardle, published in The Conversation.

To be frank, it is really quite simple. Homoeopathy isn’t “controversial”. It does not work. There is no good empiric evidence that it does, plenty of empiric evidence that it doesn’t, and entirely lacks scientific plausibility.

There is a misunderstanding of evidence-based medicine that supportive evidence of an intervention study in an RCT is equivalent to evidence of effectiveness. This is not true. If you do 20 perfectly run RCTs on inert substances using the standard for statistic significance at P < 0.05, you would expect that 1 study would demonstrate a statistically significant result. The point is, RCTs are only really valid when taken in the context of the pre-text probability of the intervention. As has been mentioned many times before, for homoeopathy (the specific intervention) to be true, we must overturn our knowledge of physics and chemistry.

The fact that the “package” of homoeopathy includes an empathic consultation is irrelevant. Yes, there may be an effect from the clinician “as therapy” but let us not fool ourselves on what is the actual therapeutic agent. It is the quality of the relationship and not the magic ritual. Homoeopathic practitioners do not acknowledge this and as such, the claim of “informed consent” is bunk. There is still the promulgation of a magical belief of what constitutes “placebo effects”.

In terms of ethics, the question really is this: is it ethical for practitioners to RECOMMEND a therapeutic modality that they know (or should know) to be inert to a patient (who is in a vulnerable position)? The simply fact is that the very act of recommendation implicitly implies that the intervention is somehow “different” or “better” than a non-recommended inert therapy. The claim of “informed consent” is thus a façade; a pretence to nominally protect the practitioner rather than to protect the patient (which is the PURPOSE of informed consent).

Fundamentally there is an ethical obligation for truth-telling on the part of medical practitioners. A RECOMMENDATION necessarily implies the superiority of an intervention over matched options. In the lack or exhaustion of acceptable scientifically-based therapies, at best we can claim that homoeopathy is not inferior to sincere and authentic supportive psychotherapeutic relationships between doctor and patient. This is what should be recommended. If patients choose to see a homoeopath (or any other time of inert therapy) then this is a personal decision that they should make themselves. This can be respected within a patient-centred model. However, I would argue that it remains unethical for a medical practitioner to actively recommend, support or practice such therapy.