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Letters to the Editor
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Complementary therapies
“Belief” article prompts comment
From Mr J. Sharp, Hon MRPharmS
Ray Sturgess’s interesting article (PDF 100K) “Belief: an
amazing healing device” (PJ, 14 May, p590) makes a number
of points which prompt comment, including: “The era of effective
medicines came in only 60 years ago. Before then there was only digitalis … mercury
compounds
… opium and aspirin.”
Although it is, indeed, true that the great majority of currently used
medicinal substances of proven efficacy were introduced only within the
past 60 years, Mr Sturgess’s second statement is untrue. Many more
than four efficacious drugs were available, and in use, before 1945,
some well before. They include arsephenamines, sulpha drugs, diamorphine,
atropine, hyoscine, strychnine, insulin, phenytoin, quinine, cocaine,
physostigmine, smallpox vaccine and diphtheria vaccine, etc. Even penicillin,
streptomycin and aminosalicylate sodium (PAS) might just about be included
in a list of effective medicines in use over 60 years ago.
To assist in the “understanding of the action of complementary
medicines”, Mr. Sturgess recalls “a classic study in a factory
in Holland” in the late 1940s. Here, after discussion with the
workers, overhead lighting was boosted. Productivity increased. However,
when the lighting was reduced to below the original level, productivity
increased yet further. Mr Sturgess may like to be aware that the classic
study along these lines, where a series of operator benefits (more breaks,
shorter hours, free hot meals and so on) were sequentially introduced,
and then sequentially taken away (with increased productivity in both
the “giving” and the “taking away” phases) is
the so-called Hawthorne experiment of the mid-1920s.1 “All new
ideas are ignored or rejected until their time is ripe. Copernicus argued
that the planets … revolved round the sun almost a century before
Galileo did.” Yes indeed, although it is not entirely true to say
that Copernicus’s ideas were “ignored or rejected” any
more than were those of Galileo. In any event, both of them were beaten
to it, in proposing a heliocentric planetary system, by around 2,000
years, by Aristarchus of Samos (ca 310–230 BC).
Having stated that “the fact is that homoeopathic preparations
have consistently failed to produce results better than those achieved
by placebos”, Mr Sturgess later states that “only those herbal
medicines that have been shown to be effective should be stocked in pharmacies”.
By this token, surely, should not this also apply to homoeopathic “remedies” which
have not been shown to be effective, that is (as Mr Sturgess indicates),
all of them?
“
The one area where complementary medicines score over conventional drugs
is in their safety.” I have seen various homoeopathic preparations
advertised for the treatment of, for example, cystitis, “piles
which ooze dark blood”, whooping cough, “burning pain in
stomach”, food poisoning, “vomiting with abdominal pains”, “falls
injuring the spine” and so on.2 Is it really “safe” to
reject proper treatment for such conditions in favour of unproven mumbo-jumbo “remedies”?
John Sharp
Woodley, Berkshire
References
1. Brown JAC. The social psychology of industry. London: Penguin Books,
1964: p69 et seq.
2. Sharp J. Some reflections on homoeopathy. Pharmaceutical Journal
1986; 236: 758-60.
“Belief response” article contains several inaccuracies
From Dr L. R. Kayne, MRPharmS
I read with interest Ray Sturgess’s article on belief (PJ,
14 May, p590 PDF (100K)). His ideas are not new — indeed many others1–3 have made similar suggestions without feeling the need to attack homoeopathy
specifically. Unfortunately, in Mr Sturgess’s haste to denigrate
the therapy, some inaccuracies have crept in.
Relatively minor errors such as the point “diluted to infinity” appear
early in the article. Although true that many homoeopathic remedies are
diluted beyond Avogadro’s number, the majority of those available
for OTC sale in pharmacies are not.
As the article continues, we find that Mr Sturgess wrongly quotes Hahnemann’s
first principle (a simple internet search reveals this is actually “similia
similibus curentur”) and continues to argue that homoeopathy has “consistently
failed to produce results better than … placebos”. Several
widely cited papers, including for example, those of Taylor/Reilly,4 Mathie5 and Linde,6 would appear to suggest that the true situation is
not quite as straightforward as this article would have us believe.
As a pharmacist, I think that the whole “homoeopathy as placebo” argument
is getting rather old now — if the patient gets better, I have
effectively performed my professional role. Is the why and how really
that important? How does one measure a placebo effect in babies, in whom
homoeopathy is widely used? I can offer many such cases, even where the
parents were sceptical… so no belief mechanism at work there. Then
there is the fact that homoeopathy appears to be beneficial in veterinary
medicine…
Mr Sturgess then proceeds to ridicule the Royal Pharmaceutical Society’s
Code of Ethics, specifically the paragraphs on complementary medicine.
I would suggest that his criticisms may again have been a little hasty
for the following reasons: a number of homoeopathic producers in the
UK hold a Medicines and Healthcare products regulatory Agency licence — surely
the definition of “a reputable source of supply”. Mr Sturgess
notes that pharmacists are apparently not prevented by the code from
selling “dubious” remedies (you can hear the manufacturers
of cough and cold preparations breathe a collective sigh of relief).
Check the BNF 49 section 3.9.2 — “there is no evidence that
any drug can specifically facilitate expectoration . . . However, a simple
expectorant mixture may serve a useful placebo function” and that “compound
preparations are on sale to the public for the treatment of coughs and
colds; the rationale for some is dubious.” Should we clear these “hocus-pocus” items
off our shelves?
A number of accredited postgraduate courses are offered for pharmacists
in complementary medicine, and the subject is taught at undergraduate
level throughout the UK.
Mr Sturgess concludes that a pharmacist’s motivation to become
involved in complementary therapies is money. This is an unnecessary
slur on the professionalism and education of those pharmacists who are
involved for a more traditional reason — helping the patient. I
am forced to wonder when Mr Sturgess was last faced with a pregnant woman
with morning sickness or a week-old baby with severe colic for whom homoeopathy
is safe and, in my experience at least, effective. Because of homoeopathy,
I have something to offer rather than an apologetic shrug.
Lee Kayne
Glasgow
References
1. Lundh LG. Placebo, belief, and health. A cognitive-emotional model.
Scandinavian Journal of Psychology 1987;28:128–43.
2. Hrobjartsson A, Gotzsche PC. Placebo interventions for all clinical
conditions. Cochrane Database Systematic Reviews. 2004;(3):CD003974.
3. Kradin R. The placebo response complex. Journal of Analytical Psychology
2004;49:617–34.
4. Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C, Aitchison TC.
Randomised controlled trial of homeopathy versus placebo in perennial
allergic rhinitis with overview of four trial series. BMJ 2000;321:471-6.
5. Mathie RT. The research evidence base for homeopathy: a fresh assessment
of the literature. Homeopathy 2003;92:84-91.
6. Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV et
al. Are the clinical effects of homeopathy placebo effects? A meta-analysis
of placebo-controlled trials. Lancet 1997;350:834-43.
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RAY STURGESS, author of the article responds:
It was predictable
that my article, proposing the belief response as the mechanism for
the working
of homoeopathy and other complementary medicines, would engender objections
from homoeopaths. Man has an innate urge to believe and many believers
remain blinkered, however convincing the contravening evidence.
G. K. Chesterton observed that when man ceases to believe in God,
he does not believe in nothing — he believes in anything. The proliferation
of complementary medicines, including homoeopathy, reflexology, Reiki,
Bach flower treatment, healing crystals and copper bangles, as Christianity
has declined, suggests that he was right.
As for homoeopathy itself, until its protagonists come up with demonstrable
evidence of its mode of action, then belief seems by far the most
likely explanation of the benefits it confers. Homoeopaths have not,
after all,
yet produced an alternative answer, in spite of having had a century
and a half to do so. |
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