My response to the Medical Post article on homeopathy

As a member of the Physician Advisory Board for the Medical Post, I sat down to read the May 10 issue and looked at the front page headline.

“The Dilution Solution”, with the subheadline stating that nearly 50% of physicians believe that homeopathic products can be helpful in certain situations.

(drops coffee mug onto the floor, shattering into a million pieces…)

For anyone who has read any of my writing, you can guess where I stand on this issue. Despite the special pleadings of the horribly misguided physicians cited in the article, homeopathy is a pseudoscience, with the overwhelming weight of the evidence showing its lack of effect compared to placebo, and its implausibility as a theory.

Evidently, 10% of physicians in Canada believe homeopathic medicine has well-established efficacy. That’s a pretty horrifying number, but probably in line with the proportion of physicians who slept through their critical appraisal classes in medical school, so I’ll believe it.

But if you’re one of the 50% of physicians that believe that homeopathic products can be helpful in certain situations, I’m directing this to you. You truly owe it to your patients to understand what homeopathy is, and why it is not harmless.

First, the story of Samuel Hahnemann. His infamous “experiment” with cinchona was deeply flawed of course, as we know that cinchona cured malaria because it contained quinine, not because “like cures like”. He also believed in miasms, which I would encourage you to read about for sheer entertainment. Thankfully, we now have 200 years of scientific discovery that disproves many of his postulates, but that has not stopped proponents of homeopathy from clinging to the theories of their founder.

It is important to distinguish homeopathic remedies from herbal remedies. A typical herbal remedy, although likely of highly questionable efficacy and safety, is still a real potential medicinal option. There is still potentially something measurable and tangible in the treatment. In a homeopathic preparation however, dilution after dilution is done, often to the extent that there is a near-zero likelihood of any active ingredient being present. The idea floated in the article that homeopathy is somehow working through nanomedicine is pseudoscience at its worst.  The thermoluminescence studies cited by Dr. Malthouse have not survived any degree of scientific scrutiny. As for Dr. Bell’s hypothesis that “low-level environmental stressors physiologically cross-adapted in varying degrees to the allostatic overload to which the individual has previously developed maladaptive responses”, I applaud her proficient use of a thesaurus.

The false balance in the article of those pro- and anti-homeopathy must be strongly condemned. Those promoting homeopathy as a legitimate treatment option are a vocal minority, and the scientific concensus showing no evidence for homeopathy is overwhelming. The U.K. and Australia have spent considerable money and resources doing high-quality analyses of the homeopathy literature, and have found no rigorous evidence to support the efficacy of homeopathy. Of course the response from homeopaths will likely be a combination of anecdotes and accusations of bias. They’ve already decided that homeopathy works, the evidence is just wrong. Those of us with a shred of scientific literacy and honesty know why their deduction process is backwards.

The pro-homeopathy physicians quoted in the article are sadly misguided when it comes to their views on homeopathy.

One physician stated that her patients use these agents to deal with physical pain, emotional stress and situations where they feel they require an “immune boost”. I completely understand the sentiment to not rock the boat when a patient with challenging, non-specific symptoms is actually doing well. But in a majority of these patients, these alternative remedies carry a significant financial burden, which we cannot ignore as their most trusted health professional. Please at least respect your patients enough to give them an explanation of why their placebo appears to be working. But don’t actively participate in the charade.

The same physician sings the praises of the placebo effect, and I’m sure she would also argue that some other common treatments in medicine are also barely more effective than placebo. But when it comes to actively recommending what you know to be a placebo, you cannot ethically recommend something you know to be inert without disclosing the relevant evidence to the patient. And remember these placebos are never free!

Another physician claimed that “there is no doubt that homeopathy works”. How any health professional with any meaningful standards for evidence can claim that is beyond me. He predictably proceeded to cherry pick a few favourable studies which supported his beliefs, while ignoring the fact that the majority of robust research has shown no benefit.

I would also warn physicians that, although some of society has embraced the inertness of homeopathy, thankfully our regulatory colleges have not been so naive.

“Allopathic medicine” was used in the article repeatedly to describe non-alternative medicine, and I hope this is the last time that I see this phrase used in the Medical Post. The term was coined by none other than Samuel Hahnemann to disparage what he viewed as mainstream medicine at the time. To continue to use this meaningless term in 2016 is insulting. There are only two kinds of medicine: medicine that the evidence shows to be efficacious, and medicine without strong evidence. As a physician, I recommend exercise, relaxation techniques, a healthy diet, and quality sleep, because the scientific evidence supports those measures. Any terms like integrative, allopathic, and holistic, are meaningless and create a false dichotomy amongst practitioners, and only serve to confuse our patients.

What is driving this inability of practitioners to honestly tell patients that there is no evidence-based treatment for their ailments? Why have we reverted back to the days of snake oil? I think much of it is rooted in the modern-day expectations of our patients, who expect answers and cures for any disease or symptom, because “it’s 2016 already”. And physicians, often on the defensive, feel a need to offer something, anything to make the patient feel better, even if it’s unproven or inert. One physician in the article stated that he “prescribed homeopathic products for patients with chronic conditions when the medical model has failed them”. But we can’t fall into that trap. We need to be the defenders of science, and evidence, and honesty. We need to be the professionals who are skilled enough to explain to our patients in an empathetic manner that we may not have definitive evidence-based solution for them, but we will continue to support them through their medical journey, and we will always look out for their best interests.

Our patients trust us as physicians to manage their health and respect their pocketbooks. We cannot allow ourselves to be dragged into the pseudoscientific world where scientific rigour appears meaningless, and anecdote trumps evidence every time. Be honest with your patients, and explain to them exactly what homeopathy is. And tell them what the evidence shows. The majority of them will make the sensible decision.


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