Does homeopathy have any place in general practice?
30 January 2008

Dr Tim Robinson is convinced of the beneficial effects of homeopathy and hopes there will be increased opportunities for its use. But Professor Edzard Ernst argues GPs should reject homeopathy as nothing more than a placebo, and instead learn to replicate its whole-person consultations.

Yes

There is definitely a place for homeopathy in general practice. Not only that, but I hope in future there will be increased opportunity for its provision. I have been offering homeopathy at my own GP practice for 12 years, with great effect. I audited my homeopathic consultations over a 12-month period and scored and analysed the outcomes. My study showed a wide variety of conditions were treated homeopathically and three-quarters of patients had a positive clinical response1. In order to defend homeopathy I want to start by sharing just three of the many cases I have treated successfully using it. In one case, a nine-year-old girl presented with a three-year history of nightmares, causing her to wake four out of seven nights each week.		Dr Tim Robinson, a GP in Beaminster, Dorset, and lecturer at Bristol Homeopathic Hospital

Three doses of one homeopathic medicine brought relief lasting about three weeks. After a further three doses she was almost completely free of nightmares – as she was when reviewed three months later.

My second case involves a 41-year-old man with a two-year history of alopecia since his mother’s death.

I treated him with two homeopathic medicines and reviewed him two months later. His alopecia was clearing – one patch had disappeared and the other was shrinking significantly.

In the third case, a 33-year-old woman came to the surgery with a four-year history of persistent diarrhoea, rectal bleeding and IBS, following Giardia infection.

In each of these cases there had been no response to medical advice or treatment, and no sign of spontaneous improvement. Each was treated within a standard 10-minute GP consultation.

Each patient was offered the choice between conventional medicine and homeopathy. Each was told the mechanism of homeopathy was not known.

The outcome of these cases was positive. The conditions were relieved and quality of life improved – which, after all the debating is done, is what we all hope to achieve.

Sceptics will remain unconvinced by my cases, and continue to claim ‘there’s nothing in it’. But there are plenty of studies demonstrating it does work, supporting anecdotal reports of its effectiveness in babies, children, cats and dogs.

The sceptics will say patients improve because of regression to the norm. The cases I have chosen certainly don’t support this – they were showing no sign of spontaneous healing.

Sceptics say patients improve because of long and repeated consultations, but all my homeopathic cases are seen within a 10-minute consultation.

Sceptics may even be as discourteous as to suggest I am deliberately misleading my patients, but I give them the choice between conventional medicine and homeopathy, and honestly state that we don’t know how or why homeopathy should work.

Unfortunately homeopathy has been tarnished by fringe elements who use it inappropriately. There are examples where patients have been advised to stop conventional medicines and claims that it can be used as an alternative to vaccination. Medically trained homeopaths (members of the Faculty of Homeopathy) would not support these claims or advocate homeopathic treatment in these situations.

I believe there is a strong case for homeopathy in general practice. It saves the NHS valuable resources by reducing GP reattendances, hospital referrals and drug expenditure, relieving suffering and improving quality of life.

If only there were more medically trained homeopaths. If only the sceptics would stop being restrained by scientific dogma and see the wider picture.

No

When leading UK scientists recently urged PCTs not to use unproven or disproven therapies such as homeopathy, they were repeatedly declared to be out of touch with the real world of medical practice. When, in December 2007, Sir David King, the Government’s chief scientific adviser, claimed homeopathy was ‘putting people’s lives at risk’, homeopaths doubted his competence. Whenever I question the value of homeopathy I am accused of being paid by big pharma and told that a professor of complementary medicine should not criticise but support homeopathy. In truth, I receive no funds from pharmaceutical companies and my role is not to support the interests of complementary medicine or its proponents but to establish the evidence and be clear about what works and what doesn’t. A professor of toxicology would not persuade people to take poison!		Professor Edzard Ernst, professor of complementary medicine, Peninsula Medical School, Exeter

Whenever we consider stating with confidence that this or that treatment is ineffective, we have problems. Science is a lousy tool for proving a negative.

To make matters worse, the scientific basis for the mechanism of homeopathy is non-existent – we are dealing with a truly implausible treatment.

This is quite different from not knowing how it works.

There are many treatments whose action is not fully understood but invariably there is the possibility of an explanation.

With homeopathy there is no such possibility that would not fly in the face of science. So, after 200 years of debate and a mountain of research, it is, I think, time to turn a page. If it looks like a placebo, tests like a placebo, behaves like a placebo, it most probably is a placebo.

Yet patients do get better after seeing a homeopath. I know that only too well, as many years ago I was a homeopath! Dozens of observational studies confirm that impression.

The contradiction between the results of rigorous research (homeopathic remedies are a placebo) and the experience in clinical practice (homeopaths help patients) is less difficult to resolve than it may at first seem.

The homeopathic encounter is lengthy. Homeopaths are empathetic and patients are expectant. So clinical improvement is almost certainly due to non-specific effects in the absence of any specific ones.

But do we care how it works? The main thing, surely, is that patients are helped?

Well, yes – but not quite. Try to treat serious conditions on the basis of placebo responses! And let’s not forget that even truly effective treatments come with the bonus of a placebo effect.

So do you want your patients to benefit from non-specific effects, from specific effects or from both?

The answer is easy – patients deserve the best and that means effective therapies administered in an empathetic way.

Rather than accepting the muddled concept of beneficial placebos in routine healthcare, we should think logically.

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.