Evidence-based medicine is not a cure-all

Dr Michael Dixon, medical director at the Prince's Foundation for Integrated Health and a GP in Cullompton, Devon, hits back at homeopathy's critics

It does get tedious. Invective after diatribe after vilification. If it's not me they are attacking then it is anyone else who dares to disagree with their diktats.

Now Professor Edzard Ernst – a leading member of science's militant tendency – insists on bombarding myself and like-minded colleagues in Pulse, our own journal.

This in a week when the BMJ published an obituary on a GP friend, Dr Kieran Sweeney, with whom I wrote two books and who knew more than most about the benefits of integrated medicine. It says: 'He saw the folly of valuing scientific evidence above all else, when hard evidence so often turned to thin ice in his consulting room.'

The new fundamentalists rarely, if ever, think about the patient. That is not surprising. Most are not doctors. Even Professor Ernst hasn't faced a real live patient for at least seventeen years. Those were the days when you could still, just, get away with 'doctor knows best'. Seems he is still living that dream.

For us who are GPs, healing is our job. We try to make some sense of the complexity of our patients' problems and offer them hope. What, I wonder, would Professor Ernst and the rest of his coterie say to the patient who comes to us in pain and distress from their fibromyalgia or chronic tiredness or frequent infections? Or the other hundred and one conditions where science has no effective answer?

They seem not to have grasped the central fact about long-term conditions. They are long-term precisely because there is no treatment – EBM or otherwise – that will cure them. All we as doctors can do is alleviate symptoms and possibly, just possibly, delay the progression of the disease. On the patient's terms if at all possible.

Evidence based medicine is not the cure-all it is made out to be. I wish it were, but if ever there were snake-oil salesmen, it is those who claim it is.

As for Professor Ernst's complaints about my comments to the Sunday Telegraph, Pulse's readers understood I said that even those who believe homeopathy provides nothing but placebo must surely accept that it sometimes helps those for whom conventional medicine has no answer.

I do not know whether the effects of homeopathy are purely placebo or whether the substance of the medicine has a biological action. In fact, I don't use homeopathy myself. I have never had the time to train in it. But I do know two things about it.

First, homeopathic doctors are neither gullible idiots nor liars. They treat their patients with compassion and professionalism, and often achieve worthwhile results.

Secondly, it is not true that science has proved homeopathy is nothing more than placebo. There is a small number of good quality, RTC trials of homeopathy – including at least one looking at fibromyalgia – that appear to demonstrate a small but significant effect greater than placebo. Data exists that indicates the effects of homeopathy may be real. For instance, in this month's International Journal of Oncology, the lead scientist from one of the most reputable cancer centres in the world has confirmed the ability of four homeopathic remedies to bring about programmed cell death in breast cancer cell lines in the laboratory.

Data is data, whether it is convenient or not. It is hardly good science to pretend it doesn't exist.

If a GP, whether a homeopath or not, tells a patient in good faith that he or she will get better, then what is the problem? If the patient gets better – even if faith, placebo or the human effect is the catalysing factor – the point is that the patient gets better. If the patient gets better simply because of suggestion (the therapeutic interaction) rather than the specific treatment, all that matters is that the patient gets better.

Professor Ernst is not interested in whether the patient gets better. He wants doctors to serve science first and our patients last, inhabiting a grey and nihilistic desert that denies the role of the doctor as healer and condemns us to being slaves of population-based statistical totalitarianism.

If I were a patient with an incurable disease, I would go for compassion over cold over-interpretation of evidence every time. But in fact, I also believe that many of the treatments that Professor Ernst seeks to rubbish do appear to work for my patients.