this week's Dr Max the Mind Doctor column in the Daily Mail (see section entitled Hokum is fine by me if it works) mentions a recent decision by a judge to reject a patient’s challenge to the Lothian Health Board’s decision to stop funding homeopathy services on the NHS (see BMJ news article). Dr Max admits homeopathy is merely placebo but says he doesn't care as long as it makes the patient feel better. He seems happy enough, I guess like a lot of doctors, to deceive his patients (see my BMJ letter, on bottom of the page from this link).
I do understand that the patient may have a different view. She apparently had found homeopathy helpful for her arthritis and anxiety. I'm not convinced the Health Board has considered the potential harm (nocebo) effect of removing a placebo, for which I guess it could be held accountable, as presumably it was originally funding the homeopathy. What I'm objecting to is Dr Max supporting the use of homeopathy, which he regards as "utter hokum".
Sunday, September 13, 2015
Hokum is not fine by me
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I think homeopathy’s anecdotal evidence-base tells a more interesting story than some clinical scientists give it credit for. Wherever we find patients, carers and/or prescribers believing homeopathy is successfully treating a mental health or behavioural concern, we have an anecdote about the power of person-centred consultation plus belief in treatment. In effect, homeopathy’s anecdotal evidence-base provides a form of placebo control for what may be (at least perceived as) achievable without active psychiatric medication. I think this sets an interesting bar for psychopharmacy, and whether prescribers can ever be sure that the effects (they think) they are observing are genuinely medicinal, given that the homeopath down the road may be observing similar results with nothing. This is especially interesting with parent/carer anecdotes about mental health/behavioural improvements in individuals who lack the capacity to psychologically invest in their homeopathic treatment, raising the strong possibility that prescribers are often also treating individuals’ emotional environments by skilfully prescribing ‘medicines’ that (often stressed and desperate) third-parties can invest in.
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