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Homeopathy isn’t unethical, it’s just controversial

The ethics of homeopathy was once again thrust into the spotlight yesterday after a leaked draft of the National Health and Medical Research Council’s statement on homeopathy revealed the agency was considering…

Manufactures and practitioners need to make consumers aware that highly diluted homeopathic remedies do not contain pharmacological doses of medicine. Shutterstock/Minerva Studio

The ethics of homeopathy was once again thrust into the spotlight yesterday after a leaked draft of the National Health and Medical Research Council’s statement on homeopathy revealed the agency was considering condemning the practice of this alternative therapy.

The NHMRC’s draft statement argues that it’s “unethical for health practitioners to treat patients using homeopathy, for the reason that homeopathy (as a medicine or procedure) has been shown not to be efficacious”.

It’s certainly appropriate for the NHMRC to make a statement on homeopathy. But it’s wrong to suggest that homeopathy itself is unethical.

Limited scope

The NHMRC claims its statement is based on a recent report on homeopathy by the United Kingdom’s Science and Technology Committee, which is similar to Senate committees in Australia.

So, rather than bringing scientists together to assess the evidence, the five-member committee (all MPs) heard from a number of experts before formulating their recommendations.

The UK government’s response noted the findings were controversial and there was significant disagreement within the scientific community. The government actively disagreed with some points, including the committee’s argument that the government should refrain from funding any further research involving homoeopathy.

It’s unclear why the NHMRC has based its draft statement on this report and ignored others from the World Health Organization, and Swiss and Canadian governments.

Informed consent

The key to the ethical practice of any therapy is informed consent – practitioners need to make patients aware of the evidence for and against their therapies.

Both manufactures and practitioners also need to make consumers aware that highly diluted homeopathic remedies do not contain pharmacological doses of medicine.

But then it’s up to the consumer to make a choice. As Steve Hambleton, president of the Australian Medical Association, stated in response to the NHMRC yesterday, if consumers are fully informed that there is no evidence a treatment is any more effective than placebo and still wish to use it, that should be the end of the matter.

And, of course, efficacy isn’t just an issue for homoeopathy. As medical writer Ray Moynihan noted recently in the British Medical Journal, most modern medicine lacks a strong evidence base, including most of the 5,000 treatments Medicare rebates are provided for.

Would the NHMRC be similarly willing to label these therapies unethical?

Critics may concede this point but say homeopathy is different – as science tells us that there is no possible way it can work. But population studies suggest homeopathy can affect patient outcomes.

It’s about practitioners, not potions

For therapies such as homeopathy, the problems don’t come from the remedies themselves; they come from unethical practitioners who put patients at risk.

The deaths of 45-year-old cancer-sufferer Penelope Dingle and nine-month-old Gloria Thomas weren’t caused by taking homeopathic remedies. Both died because they delayed more effective therapies, on the advice of their homoeopath (or in Gloria’s case, her parents delayed treatment for her eczema and eye infection).

Similarly, the public is placed at risk from homeopathic vaccinations – not because of what they contain, but because of the opportunity costs when they’re used as an alternative to real vaccination.

Problems occur when practitioners make claims for which there is no evidence, financially exploit their patients, refuse to refer when necessary and delay effective treatments for serious conditions.

Most homeopaths do not support such acts – the Australian Register of Homoeopaths supports full vaccination rather than homeopathic vaccination. But being an unregulated profession, there are always rogue operators who need to be held accountable.

In evaluating the ethics of homeopathy, the NHMRC should highlight the importance of the practitioner and the implications of Australia’s failure to regulate this industry. This has been the approach in the many countries and regions that regulate homeopaths. Ontario, Canada, for instance, is currently developing a regulatory body for homeopaths to ensure minimum standards of practice and accountability.

Does homeopathy have an effect?

The answer is no… and yes – by tweaking existing analyses and trials, you could probably make a case either way.

German insurance companies have been using population health and observational studies to investigate whether homoeopathy is an effective allocation of their resources. Studies have demonstrated good patient outcomes – as good as or better than conventional care for some conditions, even after eight years of follow-up – though results on cost-effectiveness and health service utilisation have been mixed.

The Swiss government also initiated a report that went beyond looking at clinical trials and included population heath and observational data. It concluded that homoeopathy could be both clinically and cost effective.

As I’ve written previously on The Conversation, homeopathic consultations themselves may also have some benefit, even if the medicine doesn’t.

If homoeopaths can get patients to improve without an effective medicine, we need more research to understand how this occurs.

Homeopathy as unethical

So, what would a statement that homeopathy is unethical mean?

Well, we don’t really know. It would probably mean the end of any research involving homeopathy in Australia, given that it would be hard for any research ethics committee to allow a researcher to explore a therapy deemed unethical by Australia’s major health body.

It would certainly place pressure on private health insurers to stop including homeopathy in their extras packages. But Australian private health insurers don’t pay for complementary medicine only because of their efficacy – they also offer it because it draws patients to their health plans.

In the end, branding homeopathy as unethical is unlikely to affect patient use. Most complementary medicines are patient-driven phenomena, and consumers already make the choice to use them despite mainstream medical opposition.

It may, however, stop them discussing this use with health professionals, increasing potential risks.

The NHMRC says it plans to release its final statement on homeopathy sometime this year. In the meantime, the agency should consider conducting its own investigations, and base these on a variety of international benchmarks. Simply labelling homeopathy unethical based on a single parliamentary review in the United Kingdom – and not even a scientific one – just doesn’t cut it.

Join the conversation

70 Comments sorted by

  1. Tim Scanlon

    Author and Scientist

    I'm sorry, but I would have called this unethical and the treatments involved weren't effective at all.
    "The deaths of 45-year-old cancer-sufferer Penelope Dingle and nine-month-old Gloria Thomas weren’t caused by taking homeopathic remedies. Both died because they delayed more effective therapies.."

    The treatments that are effective will become medicine, the rest are not treatments but distractions. Isn't this, by definition, unethical to support non-treatment?

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    1. Jon Wardle

      NHMRC Research Scholar, School of Population Health at University of Technology, Sydney

      In reply to Tim Scanlon

      Thanks Tim,
      That was the very point I was making in that section. However, it was the practitioners - not the 'type' of remedy - that acted irresponsibly and unethically, and they deserve to have the book thrown at them. A book that doesn't currently exist most of the time because of lack of regulation.

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    2. Steve Pratt

      logged in via email @cancerwa.asn.au

      In reply to Jon Wardle

      It strikes me that most - at least some - of the reported benefit of a homeopathic consultation is due to placebo (or meaning). For this to be strongest, the practitioner and the patient both have to believe in the effectiveness of the treatment. Declaring homeopathy ineffective, by logical extension should diminish any placebo effect, and therefore any of the perceived benefit - kind of a circular argument I suspect.

      Blaming the people not the product seems a bit simplistic. I know it's not necessarily a fair comparison, but I keep thinking of the line, "guns don't kill people, people kill people".

      All that said, I think this is a valuable public debate.

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    3. Emma Anderson

      Artist and Science Junkie

      In reply to Steve Pratt

      It seems to me people are turning to alternative therapies in part because conventional treatments are rather impersonal.

      Being poked and prodded at, rushing through the G.P, going to a hospital which is a very discomforting experience for most people (the design, the way people interact etc), the side effects of pharmaceuticals. A laundry list of reasons why people would rather drink a glass of water given to them by a smiling quack that spends time listening to them in a much ore comfortable environment.

      It is not based on fact but also common human behaviour is 1) nice people/friendly people can be trusted 2) impersonal, distant, rush rush people cannot.

      If conventional medicine was more patient-centred, more humanistic, perhaps people would stop running away to smiling quacks.

      Not that conventional medicine lacks quacks, or doesn't smile. But this what people seem to believe.

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Emma Anderson

      Ms Anderson, who do you think that people prefer to pay out-of-pocket for long consultantions with "quacks" than pay the same amount out-of-pocket to spend more time with their GP? If they did so, not only would the patient not feel rushed through but the GP would be much more likely to enjoy their work and provide a humanistic service - as well as an effective one.

      In the end, we rely on GPs (and the medical profession in general) to be available when we need them, and any time of day or day…

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    5. Emma Anderson

      Artist and Science Junkie

      In reply to Jon Wardle

      NW. I hope the message sinks in. And that when they come out as graduates, they're actually able to apply the bedside manner!

      Still I know it's TV and all that, but I'm thinking of Dr House as the unsmiling genius. It is more ethical to get cured. So what if the doctor is a vicodin snuffling arrogant ***.

      But at the same time people don't like cooperating with people like that, which makes diagnosis/treatment more difficult. And being around negative people is not always positive for…

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    6. Emma Anderson

      Artist and Science Junkie

      In reply to Sue Ieraci

      "NW. I hope the message sinks in. And that when they come out as graduates, they're actually able to apply the bedside manner!"

      I already answered your question. Admittedly unclearly.

      I am implying that there are doctors who are wish to do more than they currently are able. And health care practitioners more generally.

      Also, it's not always about paying for or being paid for a service. It's about pride in one's work, and feeling like someone cares. These things can trump payment in the desires of people but reality doesn't allow for it to be involved in decision making. $$$ = rent on clinic paid and ability to continue the service continues.

      That's why GPs are open business hours rushing through people with recurring disabilities and people clog up the ER at 2am with minor health complaints.

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    7. James Jenkin

      EFL Teacher Trainer

      In reply to Emma Anderson

      It's an interesting point. Why do people pay for something bogus?

      As you suggest, people swear alternative practitioners 'care' more, and are prepared to spend more time with a patient. But it costs. I'm sure you could find a GP who would give a similarly long consultation - and offer care and support, and focus on lifestyle factors - for the same fee.

      There must be something more profound, or so many millions of people - including qualified academics - wouldn't be convinced. Is it narcissism? Is it attraction to magic and mystery?

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    8. Sue Ieraci

      Public hospital clinician

      In reply to Emma Anderson

      Ms Anderson, are you suggesting that GPs should spend more time but be paid less than other "therapists"?

      I don't know why you maintain that GPs work business hours while people allegedly "clog up the ER at 2am with minor health complaints. You are wrong on both counts. Firstly, GPs are required to have an on-call system separate to the local hospital. There are many after-hours GP clinics (though I don't see too many after-hours CAM services).

      Secondly, EDs are NOT "clogged at 2am" with "minor health complaints" - they are "clogged" with sick and injured people getting accessible acute health care.

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    9. Emma Anderson

      Artist and Science Junkie

      In reply to Sue Ieraci

      Answering your first question - no, I am not suggesting that. I am suggesting that doctors aren't just in it for the money, however, we don't live in a fantasy land where everything is free, so they have to take money into consideration just like the rest of us.

      Actually, GPs do work business hours. Except for 24 hour medical clinics which are usually adjunct to a hospital, I have never, ever, in my travels anywhere in the country ever heard of an on-call GP. Maybe they're required to do this…

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    10. Marcello Costa

      Professor of Neurophysiology, Department of Physiology at Flinders University

      In reply to Jon Wardle

      Jon, your argument sounds terribly like the supporters of gun laws in the USA. Is people that kill not guns! they say. Well some of us think that is better not to allow too many guns. Is unethical just like selling homeopathic treatments is.

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    11. Sue Ieraci

      Public hospital clinician

      In reply to Emma Anderson

      Ms Anderson, clearly you are not aware that I have worked in EDs for almost 30 years, including being the medical director of two of them, so I have spent more time in an ED at 2am than I care to remember.

      I also know that GPs have to have either a rotating on-call or deputising service. The fact that you personally are not aware of these facts does not make them untrue.

      There are few 24 hour medical clinics these days because they are not financially viable. There are many extended-hours GP…

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    12. Sue Ieraci

      Public hospital clinician

      In reply to James Jenkin

      James - as orthodox medicine has become less paternalistic, your GP is more likely to say that they don't know the answer, that there is no medication available, or that it will take a long time to get better.

      How much more appealing, then, is the "therapist" who is an excellent communicator and appears to make you feel empowered, but is actually selling you a simple approach and a "remedy"?

      While self-empowerment and independent thought are highly regarded in our society, there still seems to be an intrinsic human desire for certainty, direction and a simple solution. Practices like homeopathy offer simple solutions under the guise of choice.

      Unhappy that the GP won't give you antibiotics for your cold, but advises you to inhale steam and drink lots of fluids? Then go to the homeopath for some Kali.S. in undetectable concentration, and they won't make you feel bad for wanting a medicine.

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    13. James Jenkin

      EFL Teacher Trainer

      In reply to Sue Ieraci

      That's a significant point Sue - do homeopaths always suggest they can cure you?

      Wouldn't it be interesting to compare the speech acts (promising, advising, consoling, warning etc) that orthodox and alternative practitioners use. That might tell us quite a lot about patients' attitudes towards the two experiences.

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  2. Colin MacGillivray

    Architect, retired, Sarawak

    Excellent article. All would be solved perhaps if homeopathy changed its name to Medical Treatment by Placebo. And practitioners of MTP were trained and obliged to direct patients, who needed medication from drug companies, to a GP.

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  3. Yoshua Wakeham

    Science Student

    This is a very interesting article, Jon. All my instincts say we shouldn't support an ineffective treatment (or Medical Treatment by Placebo, as Colin suggests), but I guess it's not that simple. One of your points does worry me, though:

    "In the end, branding homeopathy as unethical is unlikely to affect patient use ... It may, however, stop them discussing this use with health professionals, increasing potential risks."

    Surely the NHMRC has an obligation to label a medical practice as unethical or ineffective if it has sufficient evidence to reach that conclusion? Perhaps the jury is still out on homeopathy, but as a general principle, I don't see any wisdom in the NHMRC not warning people about ineffective treatments.

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    1. Jon Wardle

      NHMRC Research Scholar, School of Population Health at University of Technology, Sydney

      In reply to Yoshua Wakeham

      Thanks for the comments Yoshua. I certainly have no issue with the NHMRC publicly declaring that it thinks homeopathy is ineffective, if that is its ultimate conclusion after investigation. It is going on to then also label it unethical on top of that recommendation that I don't think is productive.

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    2. Yoshua Wakeham

      Science Student

      In reply to Jon Wardle

      That makes sense. And I think you're right that ethicality has more to do with (fully) informed consent than with the effectiveness of the treatment itself.

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    3. Tony Linde
      Tony Linde is a Friend of The Conversation.

      retired

      In reply to Jon Wardle

      I don't agree, Jon. If the NHMRC finds that homeopathy is ineffective then it must also find its practice unethical for doctors and health practitioners. For a person to self-medicate with homeopathic 'remedies', that cannot be unethical and the same also holds for someone who really believes that homeopathy works and recommends the practice to others. But doctors and health practitioners are in a position of trust and expected by patients to use the best of medical science to treat their ailments. In the case of these persons, to recommend homeopathy would be unethical behaviour: it would be akin to a christian doctor telling an ill patient to just go home and pray for a cure. If a doctor really believes in homeopathy, let them de-register and practise as a homeopathic consultant.

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    4. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Jon Wardle

      There are a number of ethical issues that surround ANY placebo, not just homoeopathy. First off is the abuse of the doctor-patient relationship, where you are basically lying to your patients, secondly is the issues that homoeopathy is not a cheap placebo, and cots as much as many conventional drugs, then there is the issue of patients subsituting working therapies for placebos, with resulting medical harm.
      Interesting articles here which point out the issues:
      https://theconversation.edu.au/mind-over-matter-the-ethics-of-using-the-placebo-effect-3752
      http://www.sciencebasedmedicine.org/index.php/placebos-as-medicine-the-ethics-of-homeopathy/
      http://www.sciencebasedmedicine.org/index.php/placebo-again/
      http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)13940-2/fulltext
      (this may require registration)

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    5. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Jon Wardle

      The article that you reference for this statement "most modern medicine lacks a strong evidence base, including most of the 5,000 treatments Medicare rebates are provided for." doesn't actually say that.
      Firstly its claim that there is no strong evidence base for modern medicine is a link to a statement on HOW the journal Clinical Evidence ranks evidence, nothing about a lack of evidence base
      http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

      Secondly its claim about…

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    6. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Jon Wardle

      "It’s unclear why the NHMRC has based its draft statement on this report and ignored others from the World Health Organization, and Swiss and Canadian governments."

      Because the former is based on up to date scientific evidence and the others are not.

      The Swiss study was a rigged review by homeopathy proponents using out of date data. See http://www.randi.org/site/index.php/swift-blog/1628-the-swiss-endorse-homeopathy.html
      2005 Review "This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects."
      http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=16125589
      2010 Review "The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo."
      http://www.ncbi.nlm.nih.gov/pubmed/20402610

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    7. Ian Musgrave

      Senior lecturer in Pharmacology at University of Adelaide

      In reply to Jon Wardle

      "The UK government’s response noted the findings were controversial and there was significant disagreement within the scientific community."

      That's not actually what the response said.
      http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117811.pdf

      "As set out in his oral evidence to the Committee (Q176), Professor
      Harper, Chief Scientist at the Department, is of the view that the majority
      of independent scientists consider the evidence for…

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  4. Luke Weston

    Physicist / electronic engineer

    Of course it's absolutely absurd and ridiculous for the UK government to claim that there is "significant disagreement within the scientific community" regarding homoeopathy. There absolutely is not, any more than there is "disagreement within the scientific community" regarding the flat earth hypothesis.

    Yes, homoeopathy, like all medical or supposedly medical procedures and treatments should be administered to patients subject to informed consent.

    But what constitutes real informed consent…

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  5. Joel Mayes

    Bicycle Mechanic

    It is unethical to lie to someone in order to sell them a product which makes their health worse.

    This is exactly what homeopaths do, not directly as the sugar pills and overpriced water they sell have no effect on the body, but by potentially delaying effective treatment.

    A question for Jon,
    I notice on your website http://jonwardle.com you use the letters ND after your name, this isn't listed in your profile here, can I ask which University you gained this qualification from?

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Joel Mayes

      Interesting question from Joel. Jon - why don't you describe yoruself in the bio above as a practising naturopath? Or is the website for your clinic out of date?

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    2. Jon Wardle

      NHMRC Research Scholar, School of Population Health at University of Technology, Sydney

      In reply to Sue Ieraci

      Thanks Sue and Joel, It is in the bio - first sentence.
      I have more qualifications in public health than I do in naturopathy. I have not used homeopathy in my practice.
      Suggesting that simply being a naturopath somehow makes me have a conflict in reporting on health topics is about as ridiculous as saying that being a medical doctor makes you similarly conflicted.

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Jon Wardle

      Jon, the bio and "disclosure" immediately adjacent to this piece makes no mention that you are a practising naturopath - which, of course, affects your reporting on health topics (as does my occupation - that's why I declare it).

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Sue Ieraci

      Failing to declare biases isn't controversial - it's unethical.

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    5. Joel Mayes

      Bicycle Mechanic

      In reply to Sue Ieraci

      We've beaten this horse to death, I've just found that but you can read parts of Jon Wardle's book "Clinical Naturopathy" online at via google scholar (It's pretty funny).

      In it both authors talk about the use of homoeopathy as a part of Naturopathy and describe it as a 'cost-effective alternative"

      This study

      http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2967177-2/abstract

      is dishonestly referenced as evidence that homoeopathic water has an therapeutic effect.

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    6. Joel Mayes

      Bicycle Mechanic

      In reply to Joel Mayes

      Jon has pointed out to me I have used the incorrect study in the above post.
      I apologise to Jon for misquoting.

      The study used in Jon's book is this one

      http://www.ncbi.nlm.nih.gov/pubmed/9310601

      Which clearly states that homoeopathy has no efficacy in any single clinical condition

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  6. Sue Ieraci

    Public hospital clinician

    Jon Wardle's claim that "most modern medicine lacks a strong evidence base" is a commonly made error of logic. Mr Wardle, each individual treatment doesn't have to be supported by a randomised control trial of effiacy to be evidence based - it has to be based on science - the clinical sciences.

    While we don't know everything about how the human body works, we know vastly more than Hahnemann knew in the 19th century. We now know through electron microscopy what cell organelles look like, through…

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    1. Jon Wardle

      NHMRC Research Scholar, School of Population Health at University of Technology, Sydney

      In reply to Sue Ieraci

      Thanks Sue. The issue of ethics still comes down to one of informed consent, not efficacy, no matter what one thinks of the value of the therapy.

      I do agree that the issue of 'arms length' is important, and I personally believe that prescribing and dispensing should be separate - I have written on this in the MJA previously as it relates to CAM https://www.mja.com.au/journal/2011/194/1/medical-merchants-conflict-interest-office-product-sales-and-notifiable-conduct

      However, to say that this…

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    2. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to Jon Wardle

      Pretending that the overwhelming consensus of scientific healthcare practitioners are still making up their minds about homeopathy is simply inaccurate.

      The principle of caveat emptor (let the buyer beware) has no place in serious healthcare. Health professionals have additional ethical responsibilities to patients and to the general public that salespeople do not have. Readers may recall this story from 2008
      http://www.theage.com.au/national/investigations/three-doctors-may-face-probe-into-links-with-supplier-20080514-2dzb.html

      Informed consent is meaningless unless a real choice is offered. You don't expect informed consent about choosing Coke over Pepsi, or KFC over Red Rooster. You do expect a full disclosure of financial interests and utter lack of scientific credibility when it comes to choosing healthcare.

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Jon Wardle

      Jon - protection against vested interests is the reason why patients require a referral from a GP (or other doctor) to a surgeon. Orthodox medicine recognises that bias and has structures set up to counter them (not perfectly, but it is a human service after all).

      I see no attempt at all from homeopaths to separate their recommendations from the sale of remedies. I am also aware of the tiny costs of the materials they use in the manufacture of 'remedies" and how much profiteering there is.

      I cannot agree that there is any form of "informed consent" that can be obtained about homeopathy other than stating that the "remedies" are inactive and that the theories they are based on are baseless.

      If you were - theoretically - obtaining informed consent for the use of homepathic remedies which you made and retailed yourself, what explanation would your provide that ensure "informed consent"?

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    4. Emma Anderson

      Artist and Science Junkie

      In reply to Sue Ieraci

      Actually Sue I am interested in what you mean by vested interests in that case. I thought that GPs referred to specialists when the condition is best address by someone with more expertise in that particular set of symptoms?

      But I agree with your points on homeopathy - it is a crock. I just think people have motives for doing things.

      Now, Michael, I think most people wouldn't be asking for informed consent on food. But people do need to know what they are eating. Arguably fast food is a bad example because it's widely articulated (if not known) that fast food is not actually good for you at all. But there are plenty of people who have to read every single label of every single food so they don't wind up in a diabetic coma or get anaphylaxis. Just because Food Packager X isn't a medical professional, doesn't mean that a great deal of expertise doesn't go into food additives etc. Or that the consequences of eating the wrong foods aren't serious.

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    5. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to Emma Anderson

      Emma, my point in mentioning foods is that the choice b/w these brands is pretty much just a matter of preference with no serious consequences. You could make the same argument comparing dishwashing liquids or any other consumer good where Brand A is essentially similar to Brand B. There is little need for the consumer to be fully briefed about the known science underlying each choice.

      I agree that individuals with specific allergies or sensitivities need extra awareness and education about what…

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  7. Gmo Pundit

    logged in via Facebook

    From David Tribe
    A very real problem with promotion of non-evidence-based medical procedures which are ineffective is that they gives licence to a whole range of allied activities which do real harm. It gives momentum to anti-vaccine, anti-fluoridation, and anti-biotechnology extremists which are harming huge numbers of people worldwide.

    It would be refreshing to see active criticism of their extremist fellow travellers who are doing considerable harm from those alternative people claiming to be ethical advocates.

    For a start consider the website for the" Australian Health Freedom Alliance", http://www.health-freedom.com.au/ and proactively tackle the range of commercialised quackery and counter-productive social activism sitting there under a deceptive banner of freedom of choice.

    It is being done in your name under your banner.

    It short, clean up your very mucky stables. And let us all know where you do the heavy lifting.

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  8. Alan Schmukler

    Homeopath

    By basing their draft statement on the discredited UK Science & Technology report, the NHMRC shows that it is not objective in any way, but trying to slander homeopathy, rather than explore it. The UK report was made by only 3 of the 14 usual members, and only one of those three actually attended the hearings. Only one practicing homeopathy was permitted to testify at the hearings, vs number of critics. The whole thing was a stacked deck with a foregone conclusion...and the NHMRC knew this when…

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    1. Citizen SG

      Citizen

      In reply to Alan Schmukler

      No worries, Alan, my mind is open... So how actually does 'making a remedy' by a 'precise process' turn distilled water into a curative agent?

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    2. Marcello Costa

      Professor of Neurophysiology, Department of Physiology at Flinders University

      In reply to Alan Schmukler

      Hi Jon,
      your article appears as a clock whenever there is need to counteract some sensible decision by regulatory bodies in stopping some outrageous alternative practices.
      How nice is to read so many sensible comments criticising every single aspect of your very weak set of arguments trying to defend homeopathy. Indeed as it was alluded in one of the responses, the fire is getting too close?

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Marcello Costa

      The disclosure statement that accompanies this piece names various sources of funding, but fails to mention that Jon Wardle is a practising naturopath who receives funding for the practice of naturopathy, another unregulated health practice. Is it possible to argue that receiving remuneration from delivering one unregulated health service does not influence one's views on the practice of other unregulated health services?

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    4. Joel Mayes

      Bicycle Mechanic

      In reply to Sue Ieraci

      If you examine his website here

      http://jonwardle.com/naturopathy-2

      In his description of naturopathy, he defines naturopathic treatment as including homoepathy. There does appear to be a clear conflict of interest

      It is also interesting (while not a direct conflict) that his clinic employs a homoeopath

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Joel Mayes

      Perhaps this statement from the site, then, is a bit disingenuous:

      "Our goal is to ensure the content is not compromised in any way. We therefore ask all authors to disclose any potential conflicts of interest before publication."

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    6. James Jenkin

      EFL Teacher Trainer

      In reply to Sue Ieraci

      I fear the Conversation's disclosure policy is a bit show-offy and a bit misleading. It suggests you have no vested interest unless you're paid as some sort of consultant - and if you're not, then everything's OK.

      I'd argue if you work within any institution - the ABC, the IPA, CSIRO, a university department - you're likely to reflect the bias of the institution. It may be unconscious, or it may well be because you know what side your proverbial bread is buttered on.

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  9. Michael Tam

    Conjoint Senior Lecturer, and Staff Specialist in General Practice at UNSW Australia

    To be frank, it is really quite simple. Homoeopathy isn't "controversial". It does not work. There is no good empiric evidence that it does, plenty of empiric evidence that it doesn't, and entirely lacks scientific plausibility.

    There is a misunderstanding of evidence-based medicine that supportive evidence of an intervention study in an RCT is equivalent to evidence of effectiveness. This is not true. If you do 20 perfectly run RCTs on inert substances using the standard for statistic significance…

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    1. Citizen SG

      Citizen

      In reply to Michael Tam

      Thanks for this article, I shall use it to demonstrate fallacious argumentation, ethical incompetence and audacious self interest in to my students.

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    2. Christopher Johnson

      logged in via LinkedIn

      In reply to Michael Tam

      It is amazing how so-called "learned" professionals denounce homeopathy for being non-evidence based, while at the same time having themselves no knowldege of the subject and basing their assertions on speculation, anecdote and belief.

      Here, Dr. Tom says there is "no good empiric evidence" that homepathy is efficacious, and "plenty of evidence" it isn't. This is blatantly false.

      Is he familiar with the totality of the homeopathic literature, going back to the first homepathic trial (Stapf…

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  10. Joel Mayes

    Bicycle Mechanic

    Another question for Jon:

    You state that the Australian Register of Homoeopaths supports full vaccination given this how do you feel it reflects on the AROH as a professional body that Isaac Golden a virulent proponent of Homoeoprophylaxis over medical immunisation is a member?

    A third question:

    The Australian Homoeopathic Association, which state all professional members must be registered with AROH has a decidedly anti-vax page here:

    http://www.homeopathyoz.org/AboutDiseasesVaccination.asp

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  11. Michael J. Lew

    Senior Lecturer, Pharmacology and Therapeutics at University of Melbourne

    It may not be beyond argument that it is unethical to provide pharmacologically inactive homeopathic remedies to a well-informed patient, but surely it is unethical to teach homeopathy.

    The two core ideas behind homeopathy are that like cures like, and that the strength of a homeopathic preparation increases with dilution (even with dilution to zero). Both of those has been proved to be false, and given the illogical, magical thinking behind them that should surprise no-one. I cannot think of a situation where it would be ethically acceptable to teach either idea as anything other than a curiosity.

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  12. Debbie Hoad

    student at University of Canberra

    "The NHMRC’s draft statement argues that it’s “unethical for health practitioners to treat patients using homeopathy, for the reason that homeopathy (as a medicine or procedure) has been shown not to be efficacious”.

    It’s certainly appropriate for the NHMRC to make a statement on homeopathy. But it’s wrong to suggest that homeopathy itself is unethical.

    In the draft statement you've quoted the NHMRC has NOT sugggested that homeopathy is unethical, but rather that practitioners of homeopathy…

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  13. Darren Saunders

    Laboratory Head at Garvan Institute

    John

    I don't see how you can defend/promote the benefits of homeopathy as a "wholistic" approach, deriving effect primarily from the practitioner rather than the "medicine", then on the other hand draw a distinction between the between the practitioner and the "medicine" when addressing the problems and ethics.

    Homeopathic vaccination is one thing, what about the example of people being given prophylactic homeopathic malaria potions? I can't see where the placebo effect is relevant here and this is clearly unethical

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  14. Christopher Johnson

    logged in via LinkedIn

    It is amazing that in this entire thread of comments, the vast majority of which claim homeopathy is inefficacious, not a single study or piece of evidence is mentioned (other than in my own reply to Dr. Tam).

    Science has known for years that no one is objective and everyone simply confirms their own pre-ordained beliefs and biases.

    It is true irony to hear these professed experts issuing their denouncement of homeopathy on the basis of it not being evidence-based, and at the same time offering no facts.

    When the evidence is properly assessed, homeopathy comes out very strongly, despite the severe lack of research funding.

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    1. Joel Mayes

      Bicycle Mechanic

      In reply to Christopher Johnson

      Christopher, when you write

      "When the evidence is properly assessed, homeopathy comes out very strongly, despite the severe lack of research funding. "

      You are being disingenuous

      The Creighton school of medicine hosts a review of clinical research into homoeopathy

      http://altmed.creighton.edu/Homeopathy/history.htm

      NCCAM in the USA has had a budget of over $1 billion dollars over the past 10 years to research "alternative" therapies has a page homoeopathy

      http://nccam.nih.gov/health/homeopathy

      The Shang review

      http://www.ncbi.nlm.nih.gov/pubmed/16125589

      Cucherat et al 2000

      http://www.springerlink.com/content/rem9l2cvglvcf81e/

      Edzard Ernst's review of reviews into homoeopath

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874503/

      All of these reviews of homoeopathy state that homoeopathy does not work.

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    2. Laurie Willberg

      Journalist

      In reply to Joel Mayes

      That link you supplied to the Creighton school is a brief bio. of Samuel Hahnemann, not a review of clinical research. The Shang review has been repeatedly discredited for not disclosing which studies were used. The recent Swiss Health Technology report of 2011 informs us that Shang overstepped his research mandate and went out into left field with cherry picked studies that merely confirmed a predetermined bias. Edzard Ernst has a well known bias against Homeopathy, and he does not disclose which…

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Laurie Willberg

      Mr willberg's comments do not suggest an understanding of scientific research methods. The conspiracy theory is a little concerning as well.

      The reason that a huge number of Indian people rely on homeopathy is that they do not have access to effective medicines. Those Indian people who can afford effective medicine use it - just like we do.

      The Indian nano-particle paper (I have read the original study) showed that, if you put water into a glass bottle and band it vigorously on a hard table…

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    4. Paul Richards

      logged in via LinkedIn

      In reply to Sue Ieraci

      " ........ particles of silica in it - from the glass!" - Sue.

      So might the cork, rubber, stopper or anything used to encapsulate the liquid in a vial. What about the particles in the air or the nano particles still attached to the sterilised glass vial. We could go on an on.

      The "elephant in the room" on this whole issue is interaction with the environment where preparations are made. At the dilute measures anything could be included e.g. a single nano particle from a blossoming tree nearby. Given the reduction of 'cure' amounts, a single nano particle of anything could alter the whole 'formula' dramatically.

      The list of variable foreign particles inside the liquid must be vast from one preparation to another of the 'cure'.

      Using a spectrum analyser to verify each preparation and would be the honest measure of the 'homeopathic preparation'. Something we certainly will never see.

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  15. Bridget Hewitt

    Project Manager

    Why do so many (often highly-educated) people use Homeopathy as part of their health-care regime?
    Because they get sufficient benefit from it. Smart people don't throw money down the tube - if they pay for something they expect a benefit - and obviously they get it if they keep going back.

    Just because double-blind clinical studies (which are often dubious and unreliable depending on who funds them) don't give a clear picture of the efficacy of Homeopathy, it doesn't mean anecdotal evidence should…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Bridget Hewitt

      Bridget - the fact that an activity is popular, or that people act against logical principles, does not make it an authentic therapy. If highly educated people only acted in logical ways, none of them would smoke, for example.

      There are many things to explain why some people feel that a particular "therapy" has benefitted them. SOme is placebo effect, some might be the support felt from the therapist, or applying some good principles (like good diet and expercise) or might be the natural course…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Ian Musgrave

      That Age piece provides an excellent analysis. In my view, "therapists" like homeopaths are "The New Paternalists." WHile it is no longer fashionable to accept the word of experts, the homeopath provides a simple and directed solution under the guise of personal choice. What they provide is the opposite of self-empowerment, however - they are using deception to provide a simple answer, and they always recommend a "remedy" - which they often market to you themselves. This is not genuine choice - it is pseudo-choice couched in pseudo-science.

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  16. Guy Hibbins

    Clinical evaluator of therapeutic goods at Monash University

    Let's be clear about this. Homeopathy was developed in the late eighteenth and early nineteenth century when bloodletting and mercury were common therapies. In many cases the standard therapies were worse than placebo.

    In this context Samuel Hahnemann developed a therapy which at least was not directly toxic. In this context it was not surprising that homeopathy became popular. No doubt if there had been randomised trials at the time, homeopathy would have fared well in comparison to standard therapy.

    This is definitely not the case today, however. If we look at meta-analyses of randomised trials of homeopathy, it scores well when the Oxford Quality Score (Jadad Score) of the trial on randomisation, blinding and follow up is 2/5 or less. If we confine ourselves to trials with a score or 3/5 or more, homeopathy scores no better than placebo, which after all is what one would expect.

    This is well described in the book "Trick or Treatment" by Ernst and Singh in 2008.

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    1. Gmo Pundit

      logged in via Facebook

      In reply to Guy Hibbins

      Can I add this quote to help readers see how good the recommended book "Trick or Treatment" is
      From Simon Singh and Edzard Ernst:

      "If we take homeopathy as an example, then millions of people are convinced that it is effective because of their own personal experiences -- they suffer various ailments, they consume a homoeopathic remedies and they feel better, so it is perfectly natural to assume that the homoeopathic remedy was responsible for their recovery. The fact that the scientific evidence…

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  17. Derek Bolton

    Retired s/w engineer

    What does informed consent mean when the consenting individual lacks scientific comprehension of the information?
    At the least, it cannot be used as a defence when the patient is an animal or a minor. Consent of a parent is not good enough. (I believe the same applies to refusal of blood transfusion for a child on religious grounds.)

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  18. John Holmes

    Agronomist - semi retired consultant

    If I formulate and register a pesticide, and it does not work, I can be sued for damages by the user of the product. How do we deal with the issue of treatments which cannot be demonstrated to work. Of course I would not expect one to get APVMA approval for that product. Sure it will pass the toxicology tests, but efficacy?

    Whats the story re human products? I would not except a solution of antibiotics to be effective at say a dilution of say 1/10000000 of a normal effective dose on a ai/kg basis.

    Of course we do not discuss the issues with a weed when we hit it with say atrazine so we do not expect any results at 1/1000000 label dose rates, so there are no physiological issues at play. We use a suitable rate for the conditions at the time.

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  19. Eric Richards

    Political Reasearcher

    The Royal Family seem to be reasonably good advertisements for homeopathy. The late Queen Mother led an active life well into her 90s and exceeded 100 before she died. The present Queen in her mid 80s is rushing around engagements like a 20 year old. No chance if they had been shackled with allopathic medicine's current favourites such as statins, or whatever the salesman recommends this week.

    I don't know the figure for Australia, but the figure for those killed by allopathic medicine in the USA in the last recorded year, I think it was 2010, is astounding. I'm sticking to homeopathy, holding down two jobs and working out at my local gym three days a week at 76. Modern medicine is pretty OK for sorting out human plumbing and scaffolding, improving all the time, but a bit of a menace otherwise.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Eric Richards

      The Royal Family are a great advertisement for living an extremely privileged life.

      Pity the majority of Indians have to use homeopathy instead, and therefore most don't get to live well into their nineties.

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  20. Alli Mac

    logged in via Facebook

    whilst it may be difficult to prove that homeopathy per se is unethical, surely it is unethical to accredit a degree in homeopathy, allow a student taking this degree to accrue a substantial debt, be eligible to receive both fee-help and aus study, only to be told at the end of the degree that their chosen field has now been deemed unethical by an official body carrying a great deal of cudos (whether deservedly or not), that has employed questionable means to measure efficacy of the modality - sounds very similiar to the cherry-picking methods utilised by the detractors of climate change, does it not? perhaps i am naive, but it seems to me that the role of science is not to discredit something on the basis of lack of understanding, but to keep researching until the mechanisms of action become clear, or???? thank you for posting a balanced, rational article - it's refreshing to read something that is factual rather than emotive in substance.

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