16 January 2010

It's not a lie if you believe it....

At the risk of inviting some very boring spam, this week I've been getting inside the debate about homeopathy, following the new year campaign by the 10:23 organisation (www.1023.org). This is a collective organised by the Merseyside Skeptics Society, and fronted by Simon Singh, to raise awareness of the truth about homeopathy, and to discourage those retailers who should know better from selling it as a remedy for anything. As well as the occasional printed media outing, a lot of chatter across the web and Twitter has been generated, and not a few wounded homeopaths wondering why the big nasty doctors have started picking on them.

I don't propose to get into the detail of the debate, which has been conducted more eloquently by others, but the centre of the debate is one of efficacy and, in particular, the Placebo Effect. The demands of science are for randomised controlled trials whose results can be openly scrutinised and whose methods can be examined. Under such harsh light, homeopathy doesn't come off too cleverly, instead finding better favour as a list of "my friend's auntie took a homeopathic remedy and it cured her sciatica" referrals. But as they say, the plural of anecdote is not data, and bona fide trials demonstrate homeopathy performs no better than placebo. To which I would say - that's not a bad outcome, considering how mad the theory is.

Placebo is not just smarties to be given to hypochondriacs but actually a powerful and profoundly mystifying phenomenon. The Placebo Effect - the successful cure of a patient using fake medicine - can be quantified into degrees of effectiveness: certain colour pills work better than others, water injections work better than fake pills, injections and pills work better after a "consultation" than self-medication. The human mind's ability to convince itself an intervention is having a healing effect and then to enable that cure is astonishing - and far more interesting than quack potion theories. If only it could be relied on under all circumstances, NHS costs would plummet, and if I were a homeopathic practitioner, I'd take the result "no better than placebo" as a compliment.

Which brings us to Boots the Chemist, Britain's leading retailer of prescription drugs. Boots has been a focus of this campaign because it continues to sell homeopathic "medicine" despite freely acknowledging the lack of evidence for efficacy. Their defence is the products' popularity with punters, ignoring the apparent chicken-and-egg relationship that might create that popularity, as an organisation in whom vulnerable ill people place a lot of trust. Boots have been looking for a way to wriggle out of this scrutiny - being accused of selling treatments they know have not been proven to work. How do they continue to rake in the profits without damaging their reputation as an upholder of pharmacological best practice?

Here's how: they claim that, in order for homeopathic products' placebo properties to be effective, the consumers must believe in their efficacy (as long as they don't read the label too carefully, or do any basic research). And what better way to reinforce that belief than by having the largest high street drug retailer in the UK selling the products? If Boots sell it, it must be all right, and the placebo effect starts at the moment the punter queues up to pay. They could claim they would be threatening the homeopathic delivery of effective placebo treatment by not selling the products.

One thing preventing such a defence from succeeding, of course, would be the homeopaths themselves. Their shrieking insistence on acceptance and legitimacy by mainstream medicine and the wider general public would never let them admit any cures they do achieve arise from placebo - which could be the basis of a legitimate practice. But, again, they themselves are in a bind, because if they admit it's all just placebo, the Placebo Effect of their treatments would be diminished. So they are forced to strive for mainstream credibility, in order to keep up what successes they presently enjoy. It's like some hippy version of the Heisenberg Uncertainty Principle. Or, rather, The Emperor's New Clothes.

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