Thursday, May 15, 2008

Orthodox Medicine, Homeopathic Medicine and 'Evidence'

Before I write more about homeopathy and evidence based medicine I feel the need to declare who I am and what sort of doctor I am. Other bloggers have described me as ‘a homeopath’ and although technically true, that is not how I would choose to position myself in medicine.

I am a medical doctor who uses a whole person orientated approach which comprises everything conventional medicine has to offer and some methodologies which it does not offer. These include Homeopathy but also Autogenic Therapy (now there is something both Prof. Ernst and I agree is an excellent adjunct to orthodox medicine) and Provocative Therapy which is the clinical application of reverse psychology in medicine and psychotherapy. Patients consult me because they know I will try to choose from these, the sort of medicine that is most appropriate for their particular situation. This could be a combination of any of the above or it might involve referral to a conventional specialist or to a member of a group of holistic physicians that I meet with on a weekly basis.

MY MENTOR: I was fortunate to have a mentor, E.K. Ledermann, a medical philosopher, psychiatrist and physician who also used homeopathy in his 70 years of holistic practice in London. He impressed on me both the importance of the mechanistic approach of orthodox scientific medicine when appropriate and the need for a holistic general practitioner to have knowledge of psychotherapy as well as some whole person orientated medical tools at his or her disposal. I see homeopathy (alongside other methods such as traditional Chinese medicine) as a powerful example of such a tool.

HOMEOPATHY: Thus homeopathy is an holistic tool that a doctor can use – but only when it is appropriate to do so. In no way does it ‘replace’ conventional medicine. In no way should it ever be used in situations where there is a risk of morbidity or mortality. In many other situations it can be used (in our opinion) to stimulate the inherent regenerative power of the body. If it fails to do the job, we homeopathic physicians are ethically obliged to use conventional medicine to do whatever it can for the patient.

It is my belief that doctors using homeopathy in their practices have served the people of Britain well (including every monarch since the early 19th century) and I am proud to be a fellow of the Faculty of Homeopathy.

Having declared who I am let me now restate what I think of the recent attacks on homeopathy on the basis that it is not scientific and particularly that it is not evidence-based medicine.

HOMEOPATHY, CONVENTIONAL MEDICINE AND ‘EVIDENCE’: Recently homeopathy has coming under stinging attacks for not being ‘evidence based’. By far the most significant of these attacks was an open letter to Patient Care Trusts by a group of British professors including Michael Baum and Edzard Ernst among others. The idea appeared to be to persuade these trusts not to allow GPs in their areas to refer patients to NHS homeopathic hospitals because homeopathy was not evidence based. Ernst went on to write a book with a journalist Simon Singh continuing these attacks and in interview also allegedly accused homeopaths of lying to their patients – an accusation that I felt morally obliged to respond to and did. Other journalists such as Ben Goldacre then joined the lynch mob and everyone continued to use evidence based medicine as the club with which to bash homeopathy.

Along the way a few lone voices occasionally cried out: ‘Hey, not all orthodox medicine is evidence based is it?’ But all the attacks on homeopathy by Ernst, Baum, Singh, Goldacre and others are based on homeopathy apparently not being evidence based which implies that orthodox medicine is evidence based. Otherwise these learned men of medicine and journalism should simply attack ALL medicine that is not evidence based, unless of course there is another agenda here.

Well I started to look at the evidence base treatments in common usage in orthodox medicine. And what did I find? A HUGE number of treatments in frequent usage and generating huge revenue for doctors and pharamaceutical companies simply cannot claim to be evidence based. A good place to prove this is the British Medical Journal of Clinical Evidence. A short time spent there will show you what I say to be true. How dare these people attack homeopathy for lacking an evidence base and by their attitude allow the public to assume that orthodox medicine is all evidence based? It’s an absolute disgrace and I’d like anyone who disagrees to tell me why.

Just for starters here is a short personal list I have of orthodox treatments that are not evidence based. If anyone thinks they are please send me the evidence and I’ll remove that item from the list. And this list is just a sample for starters. It will certainly be continued.

1. The use of drugs such as antidepressants and others for Attention Deficit Hyperactivity Disorder in children.

2. The surgical procedure of spinal fusion for many forms of back pain.

3. The use of SSRIs for depression – a treatment that costs the NHS hundreds of millions of pounds a year and yet a recent study by a highly respectable group of researchers concluded that these drugs are no better than placebo!

4. Antibiotics to prevent endocarditis
In this weeks 'placebo' issue of the BMJ there was a letter by Neil Herring and David Sprigings that expressed worry over the fact that guidelines on antibiotic prophylaxis in structural heart disease for preventing infective endocarditis have now been changed by NICE because they have found no evidence base forits effectiveness. There have been no(sic) RCTs on this subject.

5. Steroids for prevention of ARDS In the Research section there is also a paper 'Corticosteroids in the prevention and treatment of ARDS in adults; a meta-analysis' by Peter, John, Graham, Moran,George and Bersten that showed no convincing treatment effect of steroids in the condition. However the authors also state that 'meta analysis based on a small number of trials with sparse data must be cognisant of limitations in estimation of treatment effects'. You don't see people saying that about trials of homeopathic medicines do you? I wonder why not.

I must state that I don’t believe that doctors should be coerced into EXCLUSIVELY using approaches which are evidence-based. I didn’t go to medical school to become a robot. Successful medical practice is an art in which the practitioner uses the tools that suit his or her particular talents and personality. Of course in life threatening situations or where there is risk of morbidity, the standard proven protocols MUST be used. Doctors must be free to practice the art of medicine according to their own consciences. Of course if patients come to grief because of this the doctors can and will be held to account. But selectively to attack and insult a group of doctors (in this case those that use homeopathy in their practices both privately and on the NHS) on the basis that homeopathy is not evidence based while knowing full well that much of conventional medicine similarly lacks the type of evidence base they self righteously scream for in homoepathy, is in my opinion both duplicitous and pernicious.


Anonymous said...

Dr Brian, thankyou for this article. I don't understand how so much scaremongering and misinformation can be spread about this wonderful form of medicine.

I showed a skeptic the pie chart you linked to, showing the BMJ's opinion that 13% of conventional medicine is evdience based. Hw now wants the original article in which this appeared.

If you see this, could you print the name of the BMJ edition in question?

Brian Kaplan, MD said...

Hi there,

Look here: