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Commons' Committee condemns homeopathy

The Science and Technology Committee of the House of Commons has just announced its view that the NHS should cease funding homeopathy. It also concludes that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. This would mean that homeopathic medicines would no longer be licensed by the MHRA.

The stated reason for the Committee's view is that homeopathy has no effect beyond the placebo. They say that further clinical trials of homeopathy cannot be justified.

This announcement will certainly provoke a huge amount of protest both from homeopaths and from their patients, not to mention at least two members of the Royal Family. A great many patients undoubtedly do feel that they obtain benefit from homeopathy. As I say in my book, Homeopathy in Perspective (see entry above), I think homeopathy is best understood as a form of psychotherapy. Thus, although a homeopathic consultation may include the prescribing of a placebo, the whole setting contributes to the therapeutic effect. The patient has the opportunity to discuss her or his problems with a sympathetic person in a structured context. It doesn't matter if the theory is wrong. What is important is the structure - this is what differentiates the consultation from a chat with a friend. In this respect homeopathy is very similar to other forms of psychotherapy, most of which also lack a good evidence base.

The announcement from the Committee touches on the difficult subject of placebos. How ethical is it for doctors to prescribe them knowingly? The current consensus is that it involves deceiving the patient and therefore is unethical, but in fact surveys have shown that doctors still do prescribe placebos.

Moreover, it's not just homeopathy that makes use of the placebo effect: so, too, does conventional medicine. As an article in The Guardian remarked on 19 February, citing an study in The Lancet (2010;375:686-695), placebos have plenty of "real" effects on body systems. Indeed, if you think about it, you realise that this must be the case. Unless you are a dualist, believing in a separate mind hovering outside the body, the only way a placebo could work is by modifying how the brain and body work.

I think it would be a mistake to outlaw placebos entirely in clinical practice, even if that were feasible. What we need to do is to find an acceptable way of using them. We should frame descriptions that avoid deceiving the patient about what is happening. This may seem impossible - would a placebo work if the patient knew it was being used? Oddly enough, there is some evidence that it can!

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