Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

The Catch-22 of Homeopathy and Patient Choice

I have written about the fraud that is homeopathy before. Earlier this week, the British Parliament reviewed the evidence supporting on homeopathy and whether the NHS (National Health Service) should fund homeopathy. They have a lot to say. Let’s look at the area of patient choice.

Patient choice

98. Patient choice is an important concept in modern medicine. Medical practice used to be highly paternalistic, whereby the doctors would know what was best for patients and would prescribe whatever treatments they felt best. Today, doctors are trained to communicate with patients about their treatments and, while providing advice and guidance, ultimately enable patients to make informed choices, where possible, over treatment options and more control over the management of their conditions.

99. Indeed, patient choice was repeatedly cited in written submissions as a reason why homeopathy should be provided on the NHS.[120] The Minister stated:

I think there is an illiberality in saying that personal choice in an area of significant medical controversy should be completely denied, and I think the Government should be cautious about constraining that illiberality, or interfering with it. We should not take the view that patients should not be able to have homeopathic medicine when they want it.[121]

100. However, patient choice is not simply about patients being able to pick whatever treatments they like. They must understand the implications of their decisions, which means that patient choice must be informed choice. As Professor Ernst put it: “patient choice that is not guided by evidence is not choice but arbitrariness”.[122] The RPSGB echoed this view:

It is essential […] that the patient is given the appropriate information to make these informed choices and as a consequence it should be clear to the patient that there is no scientific evidence for homeopathy.[123]

101. We agree with Professor Ernst and the RPSGB. For patient choice to be real choice, patients must be adequately informed to understand the implications of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done, the effectiveness of the placebo—that is, homeopathy—may be diminished. We argue that the provision of homeopathy on the NHS, in effect, diminishes, not increases, informed patient choice.[1]

The bold highlighting is in the original document. The RPSGB is the Royal Pharmaceutical Society of Great Britain.

If we lie to the patient, we are not behaving ethically.

If we tell patients the truth, the placebo (homeopathy) is not likely to provide any benefit, since patients need to believe in placebos for placebos to work.

Footnotes:

^ 1 House of Commons – Science and Technology Committee – Fourth Report – Evidence Check 2: Homeopathy
2 NHS funding and provision
The evidence check
Homeopathy on the NHS
Patient Choice

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