Does homeopathy have any place in general practice?

As a GP since 1962 and a homeopath since 1990 most times hmeopathy is my treatment of choice. Finding the right remedy is an intellectual exercise as addictive and satisfying as doing crosswords and deeply healing - unlike orthodox drugs

In the statements above, Prof. Ernst writes: '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.'

You can be absolutely sure this is NOT going to be done. It is not being pushed for in the same way as the drive to ban GPs from referring patients to homeopathic doctors is being relentlessly driven.

Professor Ernst fails to understand the difference between an holistic and mechanistic approach in medicine. To apply an holistic stimulus such as a homeopathic remedy that suits the whole patient, you are obliged to understand the patient as a whole human being. The almost exclusively mechanistic approach of orthodox scientific medicine makes no such obligation necessary or even particularly desirable.

Perhaps Professor Ernst and the eminent scientists that are calling for doctors to be coerced and controlled (ie prevented from referring patients to NHS homeopathic doctors) should ensure most GPs first 'rediscover the value of good bedside manners, good therapeutic relationships and of seeing patients as whole individuals' before they seek to thwart the doctors that already see the necessity for doing this in order to prescribe the correct homeopathic remedy.

Jean Doherty wrote 'most times homeopathy is my treatment of choice'. Homeopathy is commonly considered as an alternative to orthodox medicine. However, most problems brought to the GP do not require any sort of medicine, they are not medical problems.

The alternative to medicine shouldn't be homeopathy (which doesn't work), but instead careful listening and sympathetic counselling about the problems of life. Why do some doctors, particularly alternativists, always feel the need to prescribe?

I find it amusing when writiers such as Dr. Ernst insist that homeopathy does not work. Has he tried it? Has he been disappointed?

It is not always easy to find the similinum (the correct remedy) but great joy rewards those who persist in the task of gaining that unique understanding of the patient and their disease. From where does the urgency to convince everyone of the ineffectiveness of homeopathy stem?

Many thousands of people in this country and countless people across the world - in every continent, use homeopathy as their first medicine of choice both in acute illnesses, first aid situations and for chronic conditions. Homeopathy can and does work in all of these situations. Writers such as Dr. Ernst are uninterested in the experiences of people who benefit daily from homeopathy.

It's almost seems as if he and others are focussed on preventing the rest of the population from knowing about the growing body of clinical evidence which shows that Homeopathy is indeed very effective. Why, why, why? I am at a loss to understand.

My wife and I are GPs. We have a daughter of 4. We have all had problems in the past which did not repond to a variety of conventional treatments. However, heomeopathy worked for all 3 of us.

For my wife and I, the initial remedy either did not work or, in my wife's case, made matters worse. However, when the right remedy was found, the effect was dramatic and long-lasting. I had symptoms for 4 years which did not respond to conventional treatment. However, I have been symptom-free now for nearly a year after the right remedy was found.

Our daughter had been unwell for several months with a variety of problems. Conventional treatment did not work. All her problems responded immediately to the first remedy and she has remained well ever since.

This is NOT the behaviour of placebo medication. I now routinely recommend homeopathy to anyone who does not respond to conventional treatment. I do not understand why homeopathy works but I have no doubt that it does. As Hamlet remarks: "There is more in heaven and earth than was dreamt of in your philosophy, Horatio".

There has to be a place in the NHS for homeopathy. And this is not because Dr Tim Robinson wants it, or Professor Ernst, an inveterate opponent of homeopathy, does not. It is because a growing number of people out here want it, and an even larger number of people are beginning to question the very safety of conventional drugs.

Yet when anyone crosses the threshold of a GP surgery or a hospital they will automatically, and with no questions asked, receive conventional medicine. This is not what the NHS should be doing - it should not be a monopoly supplier of one type of medicine. Patients should be made aware that there are alternative treatments, such as homeopathy - and they should make an informed choice as to the treatment they receive.

Professor Ernst has no right to tell me, or anyone else, what treatment I want to have, or what treatment will be made available to me. This paternalistic approach, favoured by the NHS since its inception, must end. There is plentify science that has proven homeopathy to be successful. More important, there are plenty of people, like myself, who know that homeopathy works.

Even if scientists cannot explain how it works, so what! This is a problem for science, not patients who wish only to get better. I understand that there is no 'evidence base' for some 75% of conventional treatment.

And how valuable is the evidence base for conventional drugs? Surely we have had sufficient Thalidimides and Vioxxes (and many hundreds in between) to suggest that too much science underlaying drug treatment is deeply flawed.

Steve Scrutton's arguments for NHS homeopathy are entirely fallacious. Argumentum ad populum, prescription by anecdote and meek compliance with every patient's demand for a therapy whatever it hardly a way to run any health service.

He is wrong to assume anyone going to a doctor automatically receives conventional medicine. Many conditions that GPs see might not need any drug therapy at all. If they do, the focus is on giving effective medicine, and I am afraid homeopathy just doesn't come up to scratch in this regard, however many personal anecdotes one hears about.

Homeopathy has no plausible scientific basis by which it might work and has never been shown to work in any objective, clinically relevant sense whatsoever. So let us keep our precious resources for medicines that do work, and if anyone wants homeopathy they can freely find it outside the realms of a publicly funded NHS.

Scrutton is also incorrect that there is no evidence base for 75% of conventional treatments. This oft-quoted old canard (which had its origins in an observational study of 19 GPs in 1960) is demonstrably false. Recent published studies indicate that 76% of common medical interventions have a compelling evidence base, 37% through the evidence of randomised controlled trials (1).

I see the straw men of Thalidomide and Vioxx crop up yet again. Isn't it funny how these 2 drugs are the only ones that ever seem to be mentioned out of the hundreds of failed medical therapies? Yes, conventional drugs may have side effects, but that is because unlike homeopathic remedies they have a scientific basis for their action - they actually do something!

(1) Imrie R. The evidence for evidence-based medicine. Complementary Therapies in Medicine. 2000. Volume 8, Issue 2, Pages 123-126.

Every clinician and practitioner has a stockpile of dramatic anecdotes. We are supposed also to be in possession of the discipline not to draw unreasonable inferences from them.

The curious thing is that tales of miracle cures abound in the world of Supplementary, Complementary and Alternative Medicine but they vanish like the morning mist through the simple expedient of comparing a group that has received an alternative treatment and a group that receives an apparently identical treatment that lacks only the allegedly active principle.

But what about these miracle cures? Consider: millions buy lottery tickets and millions seek alternative therapy. Someone wins the lottery every week and we are happy to call that chance. The alternative therapist does not and has the added advantage of deciding to declare the draw only when a positive change has been seen and blithely ignoring all occasions on which the hand leaves the lucky dip grasping nothing but sawdust.

Even so, there is a question that has been doing the rounds on various internet forums and to which I have yet to see and effective answer even allowing for the limitations of single-case anecdote:

Give one incontrovertible example, with references, of homeopathy curing a non-self-limiting condition.

I had predicted in responding to this item; http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4116950&c=2 that the Spence survey would be cited as evidence for the efficacy of homeopathy by one of its apologists. Perhaps I may claim my prize for a near-miss. Dr Robinson's personal "audit" stands as an effective proxy for Spence and carries just as little value when attempting to establish a claim for the efficacy of a medical therapy.

Given the nature of the conditions that homeopaths treat and the flexibility with which they allow themselves to judge success I find it not in the least surprising that at a time of the therapist's own choosing they can decide that three-quarters of their patients are not as bad as at the outset of treatment. What I do find surprising is that they regard this as evidence of the specific efficacy of their remedies.

Should there come a time when our clinical degrees require regular revalidation, any evidence of a descent into anecdotalism should allow the taxpayer to claim a refund on an expensive education wasted.

I fully appreciate that the mechanics of homeopathy is a great hurdle for many but as a jobbing GP of 28 years full time experience I have seen homeopathy work superbly well when other allopathic treatments have failed. It can be particularly beneficial to patients with eczema.

Many years ago, my then 12 year old son was plagued for years with recurrent mouth uulcers and was cured overnight by a visit to a homeopath.

The positive homeopathic experience of many vets cannot possibly be explained by placebo.

For about 10 years I had a very annoying plantar wart on my heel. I tried all the usual allopathic remedies, but it would not go away. So I tried something completely different, and against all my scientific training. Within a year it had gone. What was this remedy? Why, it was nothing at all. I did nothing, and it went away. That's the power of anecdotal evidence.

As Peter Flegg so eloquently pointed out here, argumentum ad populum (as offered by Brendan Boyle among others) applies no more to vets than it does to human physicians. The placebo effect is working on the vets and the animals' owners. They will both swear blind the poor creature is improving when it's at death's door. But don't take my word for it, just find us some evidence we can believe.

I for one am not impressed by how many credulous people there are out there. Billions believe that wine turns into blood.

I see that Dr Boyle, in suggesting that homeopathy's identity as a placebo is refuted by its veterinary use, has presented us with that unholy hybrid the straw-duck: a chimaera of strawman and canard. "The positive homeopathic experience of many vets cannot possibly be explained by placebo." No one would try to explain vets' positive experience of homeopathy by placebo. There are many better explanations for their mistaken belief.

The veterinary homeopathic 'scientific literature' is sparse in quantity, desperately poor in quality but well-tuned to creating false positive results. Veterinary homeopaths rely on their anecdotal case records as proof of the validity of their approach, but this effectively seals themselves away from scrutiny against any adequately objective yardstick. But even their case anecdotes give plenty of hints of what is really going on and veterinary homeopathy can be seen to depend for its 'success' on various things: regression to the mean, wishful thinking (made easier when neither practitioner nor client is actually themselves suffering from persisting symptoms that might force a less sunny view of the situation), avoidance of objective testing and, dare I say it, a highly enthusiastic interpretation of the facts to make the stories consistent with the preconceived notion that homeopathy works.

No 'provings', the supposed cornerstone of homeopathy, have ever been carried out in animals. Human homeopathy is simply imported wholesale and employed in animals without any significant adaptation to species differences. The concept of individualisation is thereby thrown out of the window and that window is locked and shuttered when homeopathic treatments are blanketed across herds of farm animals. Homeopathy is nothing if not flexible in its philosophy.

To the critical eye, the vaunted success of veterinary homeopathy, when it has been so over-extrapolated from its feeble human evidence-base, should in itself give the homeopaths cause for concern. Does it? Sadly, it does not.

There are in hand a couple of trials of homeopathy at the moment. One is looking at the treatment of hyperthyroidism in cats. The astonishing thing is that, previously, no veterinary homeopath seems ever to have published post-treatment T4 values. It is much easier to claim successes if one avoids objective methods of assessment that might lead to a less favourable interpretation. Indeed it was a case of feline hyperthyroidism that first sparked my interest in homeopathy, where the mere continued existence of a cat bearing all the classic clinical signs of untreated hyperthyroidism was presented as a 'successful' case. If a lingering existence in possession of a full complement of clinical signs is defined as success, no wonder homeopaths think it works.

Response to Peter Flegg: So as well as Professor Ernst telling me I cannot be treated homeopathically, Peter Flegg is now telling me too. Why? Because of their opinion which, apparently, are not 'fallacious' - like mine.

What Ernst and Flegg need to realise is that no-one is trying to prevent them from having the treatment they believe to be right. If the evidence base for ConMed is sufficient for them - fine.

Supporters of homeopathy want only one things from the NHS. Access to the treatment of THEIR choice. They have paid for it. And they are not trying to prevent other people from choosing the treatment of their choice!

"Supporters of homeopathy want only one thing from the NHS." Indeed. They want taxpayers such as me to pay for their discredited and disproven therapy and to lend spurious credibility to its private practitioners including members of the Alliance of Registered Homeopaths of which Mr Scrutton is registrar.

By exercising this "choice" in a world of finite NHS resources perhaps Mr Scrutton can explain how this does not deprive other patients of their treatment? Maybe homeopathy is paid for with limitless homeopathically diluted money.

Response to Simon Baker

And Simon, all you want from the NHS is the cosy continuation of the ConMed monopoly. And you need to ask why I should pay for the treatment you expect to receive. The NHS deprives me of homeopathic treatment; it does not deprive you of ConMed treatment. All I am asking you is choice within the NHS.

As for homeopathy being a discredited and disproven therapy - that is your opinion and you are quite welcome to it. I am, of course, writing this on the day that research has now shown that Prozac et el are ineffective - and that the drug companies did not release all the evidence it had on the drug.

A discredited medical therapy?

And if proven to be ineffective, or only effective in a particular realm of prescribing, SSRI use will be limited by various means both statutory and professional. Do you have evidence of homeopathy being held to these same standards?

I should note in passing that the Kirsch report does not say that they are literally ineffective, but that for the milder forms of depression they fail to sufficiently exceed the benefit of placebo by a defined degree that they used to signify sufficient clinical utility. Homeopathy has no consistent evidence that is effective at all beyond placebo to any degree under any circumstances. A slightly different situation, I am sure you will agree.