Professor Edzard Ernst looks at the latest in a long line of studies that have come to the same conclusion over homeopathy
Brien et al recently reported the findings of an RCT aimed at differentiating between the effects of the homeopathic remedies and the consultation [1]. Their results confirm that homeopathic remedies are placebos and show that ‘the benefits of homeopathy are attributable to the consultation'.
As frequently discussed on this blog, this is the inescapable conclusion of tons of research. Observational studies demonstrate that the homeopathic encounter can be helpful (for example [2]). Controlled trials by and large suggest that homeopathic remedies are pure placebos [3]. There is only one obvious answer: the remedies count for nothing and the encounter does it all.
Brien et al [1] argue that the placebo effect of the consultation with a homeopath is specific to homeopathy and ‘dependant on the ritual of the collaborative and highly individualized consultation necessary to identify a homeopathic remedy and associated symbolic meaning response for that patient'. But there is no evidence for that assumption, and I would question whether ineffective therapies can be vindicated through the non-specific effects they generate. A useless surgical operation, for instance, does not become useful and recommendable because it generates a host of non-specific effects which are typical of that setting.
If homeopathic remedies are ineffective and empathetic therapeutic encounters are helpful, as responsible healthcare professionals, we should discard the ineffective and adopt the helpful. If we do this, we must tell our patients that homeopathic remedies are placebos. We should be equally clear that the therapeutic relationship is important. I think (some) GPs could learn a lesson here.
Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter
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