Thursday, September 11, 2008

Let critics of homeopathy eat humble pie

I promised to use a pie to put everything into perspective and here it is - a pie baked by the highly reputable British Medical Journal’s Handbook of Clinical Evidence.

The Background: Prof. Edzard Ernst and others have repeatedly attacked homeopathy on the basis that there is no evidence to suggest that it works. Ernst even went as far as to claim that homeopaths were lying to their patients – a claim to which I took the strongest possible objection: I challenged him to a duel albeit with merely words as weapons.

In the ongoing debate there is something that never seems to be sufficiently discussed. When Ernst and company viciously attack homeopathy for not being evidence-based, the obvious implication is that orthodox, conventional medicine is indeed based on reliable evidence. There is just one little problem with this implication: It is simply not true. And here is the pie that proves this. Now please know that this is not a pie baked in my kitchen. The source of this pie is the British Medical Journal of Clinical Evidence, as respectable source of information on scientific medicine as can be found on the planet. Okay, eat, swallow, digest and assimilate this pie and then we will discuss. This pie represents the proven effectiveness of modern medical interventions or treatments.

Now let’s take a deep breath, put aside all prejudices, sit back and look at the pie again and agree on 3 facts:

1. A mere 13% of medical interventions are proven to be beneficial – ie. evidence based. I suspect that’s a lot less than you thought and hardly powerful ammunition for people like Ernst and his henchmen to use against homeopathy and alternative medicine. 13% that’s thirteen per cent.

2. 21% of interventions are ‘likely to be beneficial’. That means they are likely to help but there is no hard evidence to prove this. Hmmm, that reminds me of the many thousands of patients who say they have been helped by visits to homeopathic hospitals in England.

3. We simply don’t know if 47% of interventions are of any use at all! And we are talking about drugs and surgery here – not eating an apple a day or doing 20 minutes meditation twice a day or taking a few pills that homeopathy’s detractors describe as pure placebo.
And side effects obviously occur more frequently with orthodox drugs than they do with homeopathic medicines – a fact Ernst and co. cannot deny since they think homeopathic remedies simply cannot have any effect independent of a placebo response!

So what does this say about all the attacks on homeopathy for not being evidence based and on homeopaths for lying to their patients. Now I’m going to make some strong statements here because I believe that homeopathy’s detractors have got away with murder and this really does need to be redressed:

Ernst accused homeopaths of lying ( interview in The New Scientist on the 28th April 2008) to their patients because of lack of evidence that homeopathy works. Yet only 13% of orthodox interventions are definitely evidence based. Did he accuse orthodox doctors of lying to their patients about 87% of their treatments? Did he allow the public to assume that just about all of orthodox medicine is evidence based? Did he use evidence based medicine as a club to bash homeopathy exclusively when only 13 (sic) % of orthodox interventions are definitely evidence based. Is this unequivocally honest? Is this what we expect from a Professor of Complementary Medicine? Does this reek of bias against homeopathy? Is this in the public interest?

1. If most of medicine is not evidence based and many drugs (by their manufacturers’ admission) are capable of causing side effects, this actually means that most of orthodox medicine not only lacks evidence of its efficacy but actually can do harm. And certainly more harm than homeopathy! I find this quite stunning because it means that doctors like Ernst should be telling their patients: ‘Orthodox medicine is superior to homeopathy because homeopathy is not evidence based and at least 13 (thirteen!)% of conventional medicine is! And before you make your choice let me warn you that side effects are much more common with orthodox drugs!’ Do they do this? Do politicians ever admit mistakes? Does anybody actually say ‘Fair cop guv’?

2. Homeopathic doctors do use orthodox medicines on occasion, usually when there is an excellent indication for their use in a specific clinical condition ie. strong evidence. Could this mean that homeopathic doctors tend mainly to use the orthodox interventions that comprise the 13% of the pie that represents evidence based medicine?
So is it just possible that homeopathic doctors use only the best 13% of orthodox medicine and homeopathy for everything else? You know something – this could really be close to the truth. I don’t know of a homeopathic doctor who wouldn’t treat syphilis with penicillin or appendicitis with surgery. We do use orthodox medicine when it really does work. And we do consider orthodox medicines which may be of benefit – when homeopathy doesn’t do the trick. What we don’t do is use medicines that could do a lot of harm when there is no evidence for their use. This we leave to the huge majority of orthodox doctors some of whom (such as Ernst, Baum and co.) have the audacity to criticise us!

I suggest therefore that homeopathic doctors that are respectful of the best of orthodox medicine might just be the most efficient users of evidence based medicine. This may be true simply because orthodox doctors feel obliged to use sectors of the pie (ie 87% of it) that are not evidence based simply because they feel that they must try something. Homeopathic doctors however can use their homeopathic remedies safely instead of using drugs and surgery in situations where their efficacy has not been proved and even carries the risk of doing harm. So exactly who do the general public need protection from?

Needless to say, the attacks on homeopathy will continue. I suggest to all defenders of homeopathy that citing the pie above is the best possible defence of our art. Show it to our detractors, let them taste it and if they still refuse to eat humble pie – well then be courteous and only throw it into their faces very, very gently.

Source of the pie: BMJ Clinical Evidence Handbook, Summer 2007, Figure 1, page 4

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