But there's more to say on this. Let us assume that homeopathy, say, is nothing more than a placebo (which it is). Let's further assume that homeopathy is actually quite a good placebo, meaning that when people go to see a homeopath they generally leave feeling better and end up experiencing better health outcomes - for whatever reason. This second assumption is exactly that, an assumption, because to my knowledge no-one has done a study of whether people who use homeopathy actually feel any healthier than they would if they had never heard of homeopathy and just got on with their lives. But let's assume it works.
Now, does this mean that homeopathy is a good thing? Well, sure, if it makes people feel better, it's a good thing. However - it doesn't follow that homeopathy, or any other form of complementary and alternative medicine which works as a placebo, should be available on the NHS. Many have argued that if CAM works, even if only by the placebo effect, it's still a useful thing which the NHS should support if patient's request it. I disagree.
A while back, South Bank University in London was widely mocked for getting a psychic to give a training session on "cosmic ordering". Cosmic ordering is the belief that you can get what you want in life by placing an order with the universe in the form of wishing really hard and then some quantum stuff happens and - I can't write any more of this. It's all crap. Anyway, the head of South Bank defended the session on the grounds that the staff requested it, liked it and found it useful.Now if I applied for funding from my University to pay for a night down the pub for the whole of my Department I'd get the beaurocratic equivalent of a slap in the face. This despite the fact that people would enjoy it, it would help with team-building, and reduce stress levels. The point is that despite a Departmental night down the pub being, probably, a good thing in many ways, it's just not the kind of thing a University is responsible for. It would be incredibly unprofessional for University money to be spent on that kind of thing.
Likewise, it was unprofessional of South Bank to pay for a psychic to give a training course, even though the attendees liked it. Sorry to sound anal but Universities don't exist to give their staff what they want. They exist to pay their staff in exchange for their professional services & to help them carry out those services.
Likewise, the NHS, I think, doesn't exist to make people feel good, it exists to treat and prevent medical illnesses. So people like homeopathy and find it's helpful for relieving stress-related symptoms. Does that mean the NHS should be paying for it? Only if you believe that the NHS should also be paying for me to take a holiday to Thailand. I don't believe in homeopathy, but I do believe that a week on a Thai beach would do wonders for my stress levels. Or maybe I'd prefer a sweet guitar - I find playing guitar is great for relaxation, but it would be even better if I had a £700 model to play on. My well-being levels would just soar, if only until the novelty wore off. You get the point.
Most "complementary and alternative medicine" is medicine in appearance only. Just because homepaths hand out pills doesn't mean that what they do has anything to do with medicine. It's ritual. It's close to being entertainment, in a sense - which is not to belittle it, because entertainment is an important part of life. I'm sure there are many people for whom their sessions with their homeopath are really very useful. I just don't think the medical services should necessarily be paying for everything that people find helpful.
[BPSDB]
7 comments:
I would think that organisations like the Princes Foundation for Integrated Health could make a pretty case that services like homeopathy in the NHS could provide a useful 'feel good' service. However, whilst alt med continue to insist their treatments really work and the whole industry is filled with anti-MMR, undertrained and deluded fantasists, it would be pretty unwise to start giving them tax payers money and let them lose on a wider population.
Yes well - that's the other problem...
another fantastic blog, as we've come to expect. I think that Richard Dawkins was (unusually some might say) absolutely on the money when he said "There is no such thing as alternative medicine; there is medicine that works and medicine that doesn't." What is interesting (maybe) is how 'holistic' we take medicine to be - is it purely intrapersonal (drugs, operations) or can we expand it to actions outside the body (more like therapy?)? I've heard it said - in academic circles - that homeopaths claim that the environment is cruicial and that a lot of the RCTs that someone like Goldacre would assume were fair and balanced were in fact not as the environment was not conductive*.
This seems bizarre, but as a psychologist you are taught as early as A-Level that you are more likely to pass tests if you sit them in the room in which you studied; thatyou are more likely to overdose on a drug if you take it in a different place to usual and so on. It is implausible that this might be the case for homeopathy, but then so is the notion of a placebo effect - and it certainly exists.
I have a lot of time for Goldacre and I suspect he is probably right, but I do think there is a bit of study left in the whole idea yet.
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Not that it should be on the NHS of course - there are plenty of things that might work that aren't as you correctly note. Further, it would leave the door far too open to abuse and I for one, even (or perhaps because of that fact that I am one) as a bit of a lefty, am not happy to see people basically abuse the NHS for personal gain, which is surely what much of this amounts to, at least in theory.
G.
* Can't quite see how this claim applies to your 'AIDS vaccine on a memory stick' man, but surely noone expects a discipline like this to be internally consistent.
I always enjoy reading your thoughtful posts. My provincial health insurance used to cover a part of the fees for chiropractic treatment. Fortunately, they seem to have stopped with that. I am a firm believer in evidence-based practice.
Thanks, Penelope.
I'm also in favor of evidence-based medicine in general - but with the caveat that it can't substitute for thinking hard about what we want actually want from a treatment.
Especially when talking about placebo effects and complementary treatments that work as placebos, there is a danger that people will look at evidence finding that they "work" (generally meaning that people who volunteer for trials say that they like them) and assuming that this means that they are actually useful.
Yes, but, what about mental health services? Feel less bad...
I think the same arguments apply. In fact I'd be very worried if someone came to rely upon mental health services (CAM or "mainstream") to feel good. Health services are there to help patients to overcome whatever health problems they have. Which of course includes clinical depression or other psychiatric disorders. But it's perfectly possible to be healthy (mentally and physically) and still feel crap. In which case, the health services have nothing to offer you...
Of course it can be very difficult to tell whether someone is depressed or just feels crap, which is why it's never as simple as that. But the point remains. Health services aren't there to cater to your every need or desire, basically.
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