PEPs - Clinical Quality and Evidence

Module 2 - Evidence

Example - Homeopathy

Homeopathy has been with us for many decades with some quite powerful medical advocates. The theory is that treatment with very tiny quantities of chemicals that are known to have an effect if given in therapeutic doses will still have an important effect when given in such small quantities. The theory goes that somehow the solvent (usually water) retains a memory related to the therapy chemical and that produces the positive effect. Mainstream medicine rejects the concept yet it still persists with powerful advocates, including doctors. The most high profile proponent in the UK would be Prince Charles. Evidence is sadly lacking.

So how does such a set of treatments persist? Possibly because it fills a gap. Certainly it would be believed that it does no harm (except to the bank balance). There are other complimentary medicines and approaches, most notably manipulation of our diets, which persist. It remains incredible that Steve Jobs, probably the most technologically creative man of the decade, when diagnosed with cancer of the pancreas, resorted to diet and alternative therapies, delaying by important months the eventual surgery that he needed, rejecting the evidence and advice that he was given.

What are the factors that are at work in the alternative industry?

  • Fear of mainstream therapies
  • Fear of side effects
  • Clutching at straws when the mainstream therapies have run their course and nothing else remains
  • Arrogance that I know better than these doctors
  • Knowledge of a friend or relative who has had a bad experience or a previous personal bad experience
  • Knowledge of previous therapies that in the fullness of time have turned out to be poor or bad treatments.
  • Broadcasting of known side effects of main stream treatments without discussion of the effects of a disease if left untreated.
  • ‘Knowledge’ from the internet which has had no filter applied to it.

So as a doctor one might be confronted with any of these approaches. Only time and persuasion, with knowledge of the evidence, can deal with these. This can be very difficult but much harder when the person involved is incapable of making decisions (child or elderly with brain dysfunction) and these decisions are being made by others. In this situation, there is a safeguarding algorithm that guides us to aid with such decisions.

Please explore the following YouTube links which culminate in a debate on the subject. There is, unfortunately, a total dearth of information and science to back up the claims made.

1. James Randi explains homeopathy (Sceptic)

2. BBC Horizon Homeopathy - The test part 1 (Protagonist)

3. Homeopathy is NOT medicine (Sceptic)

4. What is Homeopathy (Protagonist)

5. Homeopathy debate - Ben Goldacre v Peter Fisher (Debate)

You might also be interested in an article relating to Prince Charles, one of the most high profile proponents of complimentary therapy:

Prince Charles 'backed homeopathy in secret talks with ministers'

Teacher's Comment

How would you manage the following scenarios?

  • A patient who has had headaches for the past 8 weeks and has heard about a Chinese remedy that she could get from the local herbalist shop for £20.
  • A mother whose child has developed occasional wheezing and wants to have acupuncture performed.
  • A retired sportsman who has developed hip pain and requests your advice on attending an osteopath.
  • A middle aged man, who is active, is not overweight and has a good diet, has had his cholesterol and BP checked at a Well Man clinic and has been advised to see you about getting statin tablets and starting on BP tablets. He does not want any such tablets with all of their important side effects and would like your approval to attend a herbalist who has advised him that she can prescribe him a tablet to deal with both of these issues.