doi: 10.1136/jme.2009.034959 2010 36: 130-131J Med Ethics

 David M Shaw 'remedies'unethical effects of funding unscientific Homeopathy is where the harm is: five

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Homeopathy is where the harmis: five unethical effects offunding unscientific ‘remedies’

David M Shaw

Homeopathic medicine is based on thetwo principles that ‘like cures like’ andthat the potency of substances increases inproportion to their dilution.1 In November2009 the UK Parliament’s Science andTechnology Committee heard evidence onhomeopathy, with several witnessesarguing that homeopathic practice is‘unethical, unreliable and pointless’.2

Although this increasing scepticism aboutthe merits of homeopathy is to bewelcomed, the unethical effects of fundinghomeopathy on the NHS are even further-reaching than has been acknowledged.

There are NHS homeopathic hospitalsin Bristol, Liverpool, Glasgow and London,and the Medicines and Healthcare Prod-ucts Regulatory Agency (MHRA) hasjudged homeopathic treatments worthyof licensing.3 4 Many patients seem tobelieve that homeopathic treatment helpsthem, as sales of homeopathic remedies inthe UK increased by 24% in the 5 years to2007.5 The British Homeopathic Associa-tion encourages visitors to its website tocontact their MPs and primary care trustsand the media in order to communicatethat their homeopathic treatment ‘waseffective, especially in comparison withconventional medicine’.6 At the committeehearing, many experts argued that therewas no evidence that homeopathy iseffective; unsurprisingly, expert homeo-paths argued the contrary. This may bedue to two different conceptions of effi-cacy, with the homeopaths arguing thattheir practice is effective inasmuch as it isas good as placebo, and the other expertsadopting the higher standard (but still thelowest for evidence-based medicine) of‘more effective than placebo’. But ifpatients believe that they are benefiting,and homeopathic remedies provide a

helpful placebo effect, then what’s theproblem?The first and most important potential

unethical effect of homeopathy is thatpatients seek homeopathic remediesinstead of, rather than as well as, tradi-tional medicine. Even for minor ailments,this could result in greater suffering forthe patient than would be the case hadthey remained within mainstream medi-cine. But in the case of serious illness,seeking homeopathic treatment could bedeadly, and the WHO recently warnedagainst homeopathic remedies for tuber-culosis, malaria and HIV.7 Homeopathicpractitioners in the UK may not berecommending such remedies, but somehave recommended to patients that theyshould not have their children vaccinated,resulting in a greater chance of harm tochildren, both directly to those not vacci-nate and through potential loss of herdimmunity.5 Homeopathic remedies are notactively harmful, as they contain no activemolecules: nonetheless, the harm done byomitting evidence-based medical treat-ment is potentially significant.Second, it is ethically dubious to spend

NHS funds on treatment that has noevidence base (beyond that of placeboeffect); NHS patients rightly expectvaluable resources to be well spent. This isall the more true if homeopathic remediesdo not actually help the patient and theythen have to seek conventional treatment,in effect making the NHS pay twice.Furthermore, any money spent onhomeopathy in the NHS could have beenspent elsewhere within the organisationon more efficacious treatments. If home-opathic remedies are unproven and mightlead to extra conventional expense, andthe money could have been better spentelsewhere, we actually have three reasonsnot to fund homeopathy on the NHS. Inresponse, it could be argued that homeo-pathic treatments are very cheap; this iscertainly true, but the NHS has only finiteresources, and every penny counts.The third ethical issue with home-

opathy is that it can involve deceiving the

patient; indeed, if the only effect isplacebo, it is probable that deception isessential to the practice of homeopathy. Ifa patient is told that he is being given aplacebo, the placebo effect will probablybe lost8; homeopaths tend to avoid thisissue by explaining the ‘scientific basis’ ofthe treatment and saying that it has‘worked’ for other people. This is perhapsbeing economical with the truth ratherthan outright deception, but the primacyof the principle of respect for autonomyand informed consent in modern medicinedemand more complete disclosure ofinformation. In order to meet these stan-dards, homeopaths would have to beentirely transparent about the evidencebase for any treatmentdand doing somight well negate any effectiveness. It ispossible that patients would still benefitfrom the time and discussion with thehomeopathic practitioner (indeed thistime and attention might form an impor-tant part of the placebo effect), but thecentral deception of the efficacy ofhomeopathic dilution is essentiallyunethical.A less direct ethical issue is that the

NHS’s support for homeopathy couldweaken patient confidence in the organ-isation, and in science and medicine moregenerally. If our national health body isprepared to fund treatment that is nobetter than the minimum standard forefficacy in evidence-based medicine, thenthe NHS is guilty of double standards ofevidencedone for evidence-based medi-cine, and another for homeopathy. It istrue that almost half of the treatmentsprovided by the NHS are of unknownefficacy,9 but at least doctors have reasonto believe that many of these treatmentsworkdthe purported mechanism behindhomeopathy has no scientific basis, and itis misleading to compare unproven home-opathic remedies without a rational basiswith unproven medical remedies withclinical reasoning behind them.10 Further-more, the MHRA’s licensing of homeo-pathic products weakens that organisation’sclaim to be evidence-based, and also plays arole in ‘undermining the rational basis formedicine’.11 In effect, if the public believesthat homeopathy is medical science, thenthis devalues both science and medicine.(The MHRA guidance for approving alicence for homeopathic remedies statesthat applicants must ‘sufficiently demon-strate that UK homoeopathic practitionerswould accept the efficacy of theproduct for the indications sought’, whichcravenly leaves it up to homeopaths todecide whether a product should get a

Dental School, Faculty of Medicine, University ofGlasgow, Glasgow, UK

Correspondence to Dr David Martin Shaw, University ofGlasgow, 378 Sauchiehall Street Glasgow G2 9JZ, UK;d.shaw@dental.gla.ac.uk

130 J Med Ethics March 2010 Vol 36 No 3

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licence.4 Furthermore, the licence itselfmight be illegal.12)

The fifth and final unethical effect isthat funding homeopathy distractsattention from the fact that there areother complementary therapies that areefficacious. Members of the public whoare unconvinced by the merits of homeo-pathy are likely to think the same thingabout all complementary/alternativemedicine, some of which is proven to bebetter than placebo. It is particularlyunfortunate that hospitals offering someeffective complementary therapies arecalled ‘homeopathic hospitals’.13 Homeo-pathy is not simply inferior to mainstreammedicine, it is inferior to some forms ofcomplementary medicine as well.

To conclude, it is likely that home-opathy is where the harm is. Althoughhomeopathic remedies do not directlyharm patients, it is very possible thatharm could befall homeopathy patientswho refrain from seeking traditionalmedicine. Patients in the NHS could beindirectly harmed if funds are spenton homeopathy that could have beenspent on mainstream care. Patients whoare prescribed homeopathic treatments arevery possibly being deceived, and thus arebeing treated unethically. And home-

opathy is currently weakening publicconfidence in the NHS, the MHRA andscience and medicine in general, and alsodoing a disservice to efficacious forms ofcomplementary medicine. Most of theseunethical effects could be minimised bywithdrawing NHS funding for homeo-pathic practice, and educating the publicabout the lack of an evidence base forhomeopathy. In other words, it would bemore ethical for the NHS to stick totreatments of proven worth. There wasonce a homeopathic hospital in TunbridgeWells, but it was closed because ‘the NHShas to decide the best use of money on theevidence of clinical effectiveness’.14 OtherNHS trusts would do well to follow thisexample.

Funding Internally funded by the University of Glasgow.

Competing interests None.

Provenance and peer review Not commissioned;externally peer reviewed.

Received 9 December 2009Accepted 16 December 2009

J Med Ethics 2010;36:130e131.doi:10.1136/jme.2009.034959

REFERENCES1. British Homeopathic Association. About

homeopathy. http://www.britishhomeopathic.org/about_homeopathy/ (accessed 12 Aug 2009).

2. O’Dowd A. Giving homeopathy on the NHS isunethical and unreliable, MPs are told. BMJ2009;339:b5080.

3. British Homeopathic Association. NHShomeopathic treatment. http://www.britishhomeopathic.org/getting_treatment/homeopathy_in_the_nhs/ (accessed 12 Aug2009).

4. Cohen D. Drugs agency grants its first licence tohomoeopathic product. BMJ 2009;338:b2055.

5. Ernst E. Harmless homeopathy? Int J Clin Rheumtol2009;4:7e10.

6. British Homeopathic Association. What you cando to help. http://www.britishhomeopathic.org/what_you_can_do/campaign_for_homeopathy/what_you_can_do_to_help.html (accessed 12 Aug2009).

7. Mastha O. WHO warns against using homoeopathyto treat serious diseases. BMJ 2009;339:b3447.

8. Shaw D. Prescribing placebos ethically. J Med Ethics2009;35:97e9.

9. Clinical Evidence. How much do we know? http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp (accessed 12 Aug 2009).

10. Gordon S. The evidence is sufficient (e-letter). BMJ.http://www.bmj.com/cgi/eletters/339/nov27_2/b5080#226079 (accessed 12 Aug 2009).

11. Evans S. Back to square one. BMJ 2009;338:b2332.

12. Colquhoun D. MHRA label seems to be illegal. BMJ2009;338:b2333.

13. University College London Hospitals. Ourhospitals. http://www.uclh.nhs.uk/Our+hospitals/Royal+London+Homoeopathic+Hospital.htm(accessed 12 Aug 2009).

14. BBC. NHS trust stops homeopathy funds. http://news.bbc.co.uk/1/hi/england/kent/7015675.stm(accessed 12 Aug 2009).

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