Placebos, self-induced healing, Homeopathy and Anti-depressants
Declaration of Interest: I am a medical doctor who has used homeopathic medicine for over 25 years and believe that homeopathy has a clinical effect independent of the placebo effect.
As the world of psychiatric medicine squirms uncomfortably with the publication of a significant meta-analysis showing that anti-depressants are unlikely to work better than placebo, it is perhaps time to consider the profound implications of this study. We are not simply talking about a single drug that has been found not to work, we are talking about an industry that gratefully accepts an estimated £380 million pounds of tax payers’ money through the NHS per year in the UK alone. This is an amount that makes the highly contraversial cost of NHS homeopathy look exceedingly trivial.
£380 million a year for drugs that ‘don’t work’? Well that is not quite true. The study did not show that the anti-depressants don’t help the people that take them; it showed that that people taking anti-depressants did not do any better than people who thought they were taking drugs for depression and in this there is a world of difference. Stated simply: Patients taking anti-depressants and patients taking dummy tablets both felt better.
To me it is clear that both sets of patients got better for one simple reason. They both thought that the drugs would to them good. Why did they think this? Because in the consultation with the doctor or psychiatrist who prescribed the drugs they were convinced that the pills would help them. This was made possible by the fact that the doctors prescribing the anti-depressants were convinced that they would help their patients and this conviction was passed on to the patients resulting in the so-called ‘placebo effect’. I don’t like the term ‘placebo effect’ which feels contemptuous and patronising to patients. It is fairer to say that these patients healed themselves because they had confidence in their medication. I don’t believe that they were conned at all. Their doctors believed the drugs would work and certainly were not ‘conning’ anyone. If there is any con here it can only be that the doctors were conned somewhere along the line – whether this be by over-enthusiastic advertising by Big Pharma, or that Big Pharma failed to publish unfavourable data. The drugs and placebo would not have had such a good clinical effect if doctors knew they were giving physiologically ineffective placebos to their patients. Inauthentic doctoring has a bad smell easily detected by patients and tends to be anti-therapeutic. Thus the big question is why did so many depressed patients feel better on placebo or ineffective medications?
The answer is surely in the body-mind connection which holistic practitioners have been ‘going on’ about for decades, if not centuries. There is art in medicine and this art is in the consultation. The findings of this study show just how clinically powerful the consultation can be – even in the long term.
In the light of this, let us revisit the controversy surrounding patients receiving homeopathic medicine on the NHS. As I have stated the amount of money this costs the tax payer is trivial compared to the costs of the anti-depressants apparently now shown to be no better than placebo but such financial considerations are not my main point. Homeopathic medicine has been attacked by a group of doctors who say that it should not be funded by the NHS because although it clearly helps patients, it performs no better than placebo. I disagree with this as stated clearly in my declaration of interest at the start of this essay. However let me pretend for a moment that these expert doctors are correct and that homeopathic doctors are only getting results because of their bedside manner and the belief of both them and their patients that homeopathy has a clinical effect. The idea that homeopathy is a ‘con’ is ridiculous if you at least accept that homeopathic doctors believe that their medicines have a clinical effect – a necessary condition to provide an atmosphere of authenticity in the consulting room which is essential for getting results through ‘suggestion’.
If we compare homeopathy to these anti-depressants (again as viewed by those who believe that homeopathy only works through suggestion) we see two groups of patients both getting better due to the ‘placebo effect’ or self-induced healing. However the homeopathic patients apparently received placebo while the other group definitely receive drugs that act on the chemistry of the brain. Yet it is only the prescribers of the non-chemical so-called placebos who are being told that they should not be allowed to treat patients on the NHS. This is clearly a travesty.
As stated above, I believe that homeopathy works beyond the placebo effect but I say this to those who ridicule it because they believe it is ‘no better than placebo’: Homeopathy is not a ‘con’ because the thousands of medically qualified doctors practising it do believe that it is clinically effective and would not get results or bother to spend many years studying it if they did not believe in its clinically efficacity. I believe my patients get better because homeopathic medication works. To those who think that is only because I believe this that my patients get better I would say the following: How do you suggest that doctors get their patients better by getting them to believe that their health will improve? Prof. Ernst, one of homeopathy’s most vociferous detractors has stated:
If certain practitioners such as homeopaths are good at maximising placebo effects, why not learn how to do it? Why not maximise placebo effects when prescribing genuinely effective treatments? If we start systematically investigating how to achieve this, we are likely to rediscover the value of good bedside manners, good therapeutic relationships and of seeing patients as whole individuals.Then patients might no longer feel the need to consult homeopaths in the first place.
I find this statement incredible and naive. When will this ‘systematic investigation’ begin? And much more importantly – why try to prevent patients getting this sort of healing before doctors are educated in some sort of new paradigm of medicine at which he vaguely hints. I find it deeply disturbing that Ernst and his colleagues would choose to attack homeopathy instead of working very hard indeed on this ‘systematic investigation’ in search of what they clearly believe is the healing power of the homeopathic consultation alone and then finding a way of teaching doctors to utilise it. Until then would it not be more logical to avoid attacking homeopathic doctors and campaigning against NHS homeopathy? When a new paradigm of medicine emerges and patients are helped to heal themselves by some new system of applying mind-body medicine, that would be a logical time for them (if not me) to revisit the necessity of homeopathy. Attacks on homeopathic medicine before that time can be considered hypocritical, disingenuous and clearly not in the interest of any patients whatsoever.