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Posts Tagged ‘evidence-based medicine’

Homeopathy: the scientific proofs of efficacy

Monday, November 12th, 2007

“The opposite of a fact is falsehood, but the opposite of one profound truth may very well be another profound truth.”
Niels Bohr

“The world of homeopathic research is moving in the direction of investigating its rational, explicable, demonstrable, reproducible aspects and neglecting the more controversial and doubtful aspects. The purpose of this publication is to review the extensive literature available, and draw the reader’s attention to studies that comply with the strictest scientific methodologies.”

This Italian literature review, published in 2002, is available in English translation from the Italian homeopathic pharmacy Guna, and presents a comprehensive review of the trials of the last decade, summarised by an Advisory Board which includes professors in Immunology, Pharmacology, General Surgery, Clinical Morphology and Anatomy, Human Physiology, Psychiatry and Neurology from universities and medical schools in Italy, the US, Germany and Poland. Some salient quotations from the study:

“A number of large-scale studies designed to evaluate the huge amount of homeopathic literature have been conducted, especially in the last 10 years. Organisations and institutes of great international prestige and importance have dealt with the issue of homeopathy. All of them have concluded that homeopathy possesses therapeutic efficacy.” (Overview of Human Clinical Trials, p29)

“… most of the members of the medical profession and the media have failed to perceive the existence of this body of studies, which demonstrate the therapeutic efficacy of homeopathic medicines. The aim of the present volume was to fill this lack of information by a compendium made of some of the latest and most significant literature in the field.
Very briefly, a large body of studies demonstrates that the efficacy of homeopathic medicines is not due to the “mythical” placebo effect, thus finally dispelling a series of superficial, prejudiced attitudes.

“Among these, a set of studies compare homeopathic vs allopathic medicines. These trials were conducted in accordance with Helsinki Declaration on the therapeutic efficacy.
Most of the best studies relate to the branch of homeopathy known as homotoxicology which, with its pragmatic attitude and rejection of therapeutic extremism, seems to meet current demand for integrated medicine most effectively.
These studies demonstrate that the effect of homeopathic medicines may be at least similar to that of the allopathic reference drug used for the same disorder. They also confirm that homeopathic medicines, unlike allopathic drugs, rarely produce side effects. Finally, they show that homeopathic remedies are usually cheaper,and in some cases much cheaper, than the corresponding conventional treatment.

“Everybody is entitled to his own opinion and can deny the evidence, even when faced with the clearest proof. But who hold public and institutional offices and responsibilities have the duty to analyse actively all the body of information that may improve the patient’s quality of life.

[...]

“It may seem paradoxical that tiny amounts of an active constituent (diluted by the very special process of homeopathic production) can produce effects on living beings, but this is evidently a scientific fact.
Science acts on the basis of objective, verifiable observations; if the event demonstrated cannot be interpreted by a theory, it is the theory that needs to be revised. This is the principle behind the progress of science.” (Conclusions, p87-88)

This study was published in 2002. In 2005, the World Health Organisation were in the process of compiling what was believed to be a largely positive report on homeopathy, and which was apparently leaked to The Lancet in advance of its publication of the Shang et al meta-analysis. According to Dr Peter Fisher, Director of Research at the Royal London Homeopathic Hospital and the Queen’s homeopath:

“The same issue of The Lancet featured a leak of the World Health Organisation’s (WHO) draft report on homeopathy. The WHO document was apparently leaked to The Lancet by Dutch and Belgian doctors hostile to homeopathy; their comments and the (hostile) comments of Prof. Edzard Ernst of the University of Exeter were published. Dr Xiaorui Zhang, Traditional Medicine Coordinator of WHO, who is responsible for the report, was also interviewed, but declined to comment on a leaked, confidential draft. This leak came only 2 days after The Times of London published, as its front page lead, a remarkably similar story: a leak of the Smallwood Enquiry on The Role of Complementary and Alternative Medicine in the NHS commissioned by The Prince of Wales’ Foundation for Integrated Health. It is ironic that the editor of The Lancet, Dr Richard Horton, wrote to The Times accusing Prof. Ernst of having ‘broken every code of scientific behaviour’ for leaking the draft report of the Smallwood Enquiry (and incidentally describing complementary medicine as ‘a largely pernicious influence… preying on the fears and uncertainties of the sick’), while simultaneously doing the same to the WHO report in his own journal!

“Dr Horton also wrote an open letter to the UK Secretary of State for Health, Patricia Hewitt and the Chairman of the National Institute for Clinical Excellence (NICE) Prof. Sir Michael Rawlings, calling for the use of homeopathy in the NHS to be reviewed in light of this publication.”

What we appear to be looking at here is a very deliberate attempt to discredit homeopathy, allowing prejudice to hold sway over the results of scientific studies and making a mockery of evidence-based medicine. Not only are these individuals attempting to mislead the medical profession and general public, but are trying to deprive them of the right to choose and use a healthcare modality which is rapidly being reliably demonstrated as at least as effective as conventional medicine, and in some instances, more so. Futher, one that is also proving itself to be considerably cheaper than the present model and highly unlikely to kill upwards of 106,000 people per annum (in the US alone – Journal of the American Medical Association 2000;284:483-485) just through the side effects of the medication.

If The Lancet remains true to previous form in its next issue on homeopathy, then it doesn’t look like it has much future as a respected scientific journal under its present stewardship. That’s a shame, as it’s one of the oldest peer-reviewed medical journals in the world (founded in 1823). Homeopathy will survive, as it has done for longer than The Lancet despite all previous attempts to suppress it, because the truth has a way of finding its way out regardless.

If you support freedom of choice in healthcare and have had good experience of homeopathic treatment, you can register your support by signing the “homeopathy worked for me” declaration.

“In a time of universal deceit, telling the truth becomes a revolutionary act.”
George Orwell

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PEKing out the bias

Sunday, November 11th, 2007

Lancet Vol 366, Issue 9487, 27 August 2005 

“Research is subordinated (not to a long-term social benefit) but to an immediate commercial profit. Currently, disease (not health) is one of the major sources of profit for the pharmaceutical industry, and the doctors are willing agents of those profits.”
Dr Pierre Bosquet, Nouvelle Critique, France, May 1961

As The Lancet prepares to publish another issue on homeopathy, this seems a suitable moment to republish a blog entry from 18 months ago which described the highly irregular context forming the backdrop to the publication of the seriously flawed study (Shang et al. ‘Are the clinical effects of homeopathy placebo effects? Comparative study of placebo controlled trials of homeopathy and allopathy’ The Lancet 2005;366 (9487):726-733) which claimed to support the conclusion that the effects of homeopathy are no more than placebo.

Further details on the study itself, analyses of it’s principal failings, and the reaction it provoked among serious researchers can be found on the Myths and Misconceptions page.

The Shang et al meta-analysis was an offshoot from a Swiss government study, the Programm Evaluation Komplementärmedizin (PEK), which was designed to allow politicians to assess whether or not five complementary therapies – anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese herbal therapy – should be included in the list of services covered by the Swiss compulsory health insurance scheme (KLV). The cost of complementary therapies were, until 1998, reimbursed under the basic national scheme, but a change in the regulations in 1998 put the decision over which therapies were or were not valid for reimbursement in the hands of the Swiss Department of Internal Affairs (EDI). Public outcry forced the government to back-peddle and the five most popular therapies were reinstated in the KLV scheme from 1999 to 2005, on condition that each therapy was provided by FMH-certified physicians only, and that a simultaneous study in each therapy’s effectiveness was carried out (the PEK study). The decision on whether the therapies were retained within the basic health insurance scheme after 2005 would depend on the demonstration of their efficacy, appropriateness and cost effectiveness.

The study was set up under the Federal Office of Social Insurance (BSV) with a well-defined management structure and review board of internationally-acknowledged experts. It received widespread praise for the quality of its design and the degree of cooperation and transparency amongst its participants. As each area of the study began publishing their findings, the project was cited as an exemplar for future CAM research.

But as the extent of the findings in favour of the five therapies began to become clear, in 2004 PEK’s management structure was abruptly changed and the control of the study was passed to the Federal Office of Health (BAG). From that point onward, many attempts were made to interfere with and derail its emerging conclusions. Transparency was immediately compromised. Economic data showing the cost benefits of CAM were suppressed. The economist preparing to present the results of his work was dismissed without reason and placed under a gagging order. Other departments were prevented from publishing their work.

One member of the PEK steering committee, Dr med Peter Heusser, was so disgusted by what he witnessed that he has written an account of what happened, Medizin und Macht am Beispiel des Programms Evaluation Komplementärmedizin PEK (currently only available in German, but machine-translated here), and this brief summary is drawn largely from his account.

The Swiss authorities – both the government and the Federal Office of Health (BAG) – tried to sweep the PEK study under the carpet. A conference scheduled for April 2005 to present and discuss its results had to be cancelled because the Federal Office of Health prevented the publication of the study data. Some collaborators were even coerced into deleting all PEK-related data from their computers. The final meeting of the PEK international review board (six professors from Switzerland, Germany, Denmark and the UK responsible for the scientific quality of the study), scheduled for June 2005 for a final assessment of the project, was cancelled. (The review board eventually produced a summary report in September, which is highly critical of the political interference in the study.) Many contributors had their contracts terminated before their work could be completed. The recommendation in the final draft that homeopathy, anthroposophical medicine and herbal medicine should stay in the compulsory health insurance scheme was deleted in the final publication.

The Swiss government pre-emptively decided to exclude all CAM therapies from the compulsory health insurance scheme as of 30 June 2005, effectively ignoring not just the weight of scientific findings and economic benefits (which could save SFr millions on the health budget) which were emerging from the still-to-be-completed PEK study, but also the weight of Swiss public opinion.

In this context, the appearance of the Shang et al meta-analysis in The Lancet two months later – notably pre-empting the final report from the PEK international review board – can do little else but appear even more biased and reverse-engineered than it does already in its own right (see Myths and Misconceptions). A letter to The Lancet from the Swiss Association of Homeopathic Physicians raising objections to the study was not even granted publication.

None of this – aside from the initial frenzy surrounding the announcement of the conclusions of the meta-analysis on homeopathy – appears to have raised so much as a whisper from the English-speaking international media. Even in Switzerland it was only reported piecemeal so the full extent of what happened was not readily apparent.

Perhaps it’s worth noting that Switzerland is ranked as 8th most competitive nation in the 2005 World Competitiveness Yearbook. (In comparison, the UK came 22nd.) And it’s also ranked 8th in terms of the major exporting countries of chemical and pharmaceutical products. Around 5% of current global pharmaceutical R&D is attributable to Swiss companies. Just one of these companies, Roche Holding AG, parent company of Roche Pharmaceuticals, the manufacturers of the anti-viral drug Tamiflu, reported 2006 net income which was greater than the entire gross domestic product – that is, the value of all final goods and services produced within a nation in a given year – of the bottom 119 nations of the World Bank’s 183-nation rankings in 2005.

Since many university medical research laboratories would cease to exist without the support of the pharmaceutical industry, it’s perhaps no surprise that “at the end of 2004, professors of the medical faculties had expressed the intention at a meeting of the Swiss Academy of Medical Sciences … to do everything in their power to prevent complementary medicine remaining in the basic insurance. A dean voiced the prevailing opinion: “We must provide hand grenades [literal quotation, personal communication of a participant of that conference] against complementary medicine.”" (Dr med Peter Heusser).

Against the backdrop of more and more high-quality studies demonstrating the clinical effectiveness of homeopathy in practice, it will be interesting to see if The Lancet can recover its scientific credibility this time around, or whether this will turn out to be yet another ill-conceived attempt at a hatchet job jumping on the Colquhoun-Goldacre bandwagon.

“The prerequisite for today’s medical policy is naturally the currently predominant system of medicine. The sick are the source of income, therefore it is necessary for sick people to be there, yes, it proves advantageous if one makes the people artificially sick.”
Dr med Steintl: ‘International Medical Policy’, 1938, Berlin

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Desperate Dan

Saturday, February 3rd, 2007

Vitamins

“An error does not become truth by reason of multiplied propagation, nor does truth become error because nobody sees it.”
Mahatma Gandhi

On January 16, the New York Times published an essay by author Dan Hurley entitled “Dietary Supplements and Safety: Some Disquieting Data.” The essay makes for unsettling reading.

Hurley writes:

“Since 1983, the American Association of Poison Control Centers has kept statistics on reports of poisonings for every type of substance, including dietary supplements. That first year, there were 14,006 reports related to the use of vitamins, minerals, essential oils – which are not classified as a dietary supplement but are widely sold in supplement stores for a variety of uses – and homeopathic remedies. Herbs were not categorized that year, because they were rarely used then.

“By 2005, the number had grown ninefold: 125,595 incidents were reported related to vitamins, minerals, essential oils, herbs and other supplements. In all, over the 23-year span, the association – a national organization of state and local poison centers – has received more than 1.6 million reports of adverse reactions to such products, including 251,799 that were serious enough to require hospitalization. From 1983 to 2004 there were 230 reported deaths from supplements, with the yearly numbers rising from 4 in 1994, the year the supplement bill passed, to a record 27 in 2005.”

He goes on to elaborate, breaking down the statistics according to the number of reported adverse reactions, hospitalisations and deaths linked to vitamins, minerals, herbs, homeopathic remedies, etc. “Homeopathic products, often marketed as being safe because the doses are very low, were linked to 7,049 reactions, including 564 hospitalizations and 2 deaths.”

To any complementary medical practitioner and user, and anyone who purchases and uses dietary supplements, this article is worrying. But not necessarily for the obvious reasons.

At the end of the essay we read “Dan Hurley is the author of the new book ”Natural Causes: Death, Lies and Politics in America’s Vitamin and Herbal Supplement Industry” (Broadway Books), from which this essay is adapted.” In his research for the book, Hurley (a regular contributor to the “Science Times” section of the New York Times with 15 years’ experience as a medical reporter for publications ranging from Medical Tribune to Family Circle and Psychology Today), claims to have spent nearly two years reviewing studies and court cases, speaking with politicians and public-policy experts and interviewing physicians, pharmacists, nurses, toxicologists, epidemiologists and public health officials, as well as victims and their families. His analysis of 23 years of data from the US Poison Control Centers was what was extracted from the book to form the basis of the NYT article.

However Michael Levin, a healthcare consultant who has served in executive positions in both pharmaceutical and dietary supplement businesses, was suspicious of the figures. Levin immediately researched Hurley’s claims and promptly wrote to the New York Times. His letter has not been published but the full text of it is available here on John Weeks’ The Integrator Blog.

He writes:

“Mr. Hurley’s essay regarding the safety of vitamins and dietary supplements was, indeed, disquieting. He referred to “a national database accumulating strong evidence that some supplements carry risks of injury and death, and that children may be particularly vulnerable.”

“In examining that database (“2005 Annual Report of the American Association of Poison Control Centers’ National Poisoning and Exposure Database”, Lai, et al, Clinical Toxicology, 44:803-932, 2006), it became clear that Mr. Hurley’s “disquieting data” is wholly misleading and utterly unfounded. His bias is reflected in the fact that he did not disclose to his readers that the statistics he cited included suicide attempts, multiple drug use and events related to children’s misadventures in the household medicine cabinet.

Hurley, in his NYT essay, attempts to pre-empt the obvious riposte from the dietary supplement industry by arguing:

“Advocates of the products correctly point out that the poison centers’ figures do not prove a causal link between a product and a reaction and that, in any case, far more people are injured and killed by drugs. Painkillers alone were associated with 283,253 adverse reactions in 2005, according to the poison centers, more than twice as many as with supplements. But only 3.5 percent of those reactions occurred when people took the prescribed amount of painkiller; most were from overdoses, either accidental or intentional. The same was true of asthma drugs (3.6 percent of reactions were associated with the prescribed dose) and cough and cold drugs (3.1 percent).

but apparently fails to apply the same logic to his own analysis of the data on supplements and alternative treatments. Levin writes:

“Regarding deaths from all causes: Dr. Lai, et. al. reports “of the 1,261 human poisoning fatalities reported, 89.6% of adolescent deaths and 76.6% of adult deaths (older than 19 years) were intentional” (page 811). Clearly, the vast majority of deaths were deliberate acts which have absolutely no reflection whatsoever on the safety of the products involved when they are used as directed or prescribed.”

and goes on to break the data down further, showing in each instance the extent of Hurley’s manipulation of the figures.

While it would be ludicrous to suggest that alternative medical techniques and treatments and dietary supplements are incapable of causing adverse reactions, or that those participating in the dietary supplement industry and alternative medical practice are all as pure as the driven snow – every area of life, without exception, has its ethical and unethical representatives and practices – sensationalist articles such as Hurley’s do nothing to advance the cause of evidence-based medicine. The New York Times (not to mention The Lancet), once regarded as a publication of integrity and reliability, has clearly been co-opted into promoting agendas which have nothing whatsoever to do with reliable, robust science.

Yet the attempts of the medical mainstream to discredit alternative and complementary treatments are beginning to look more and more desperate. It’s heartening to see that for all the extensive resources being thrown at these exercises, the truth still manages to find its way out somehow.

“There are two ways to be fooled. One is to believe what isn’t true; the other is to refuse to believe what is true.”
Søren Kierkegaard

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Evidence? What evidence?

Tuesday, May 23rd, 2006

“I know that most men, including those at ease with problems of greatest complexity, can seldom accept even the simplest and most obvious truth if it would be such as oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives.”
Leo Tolstoy

And so it goes on …

It really is extraordinary to what lengths people will go to try to keep the world within their comfort zones. Whatever happened to the concepts of open mindedness and free choice?

Today we have Michael Baum, emeritus professor of surgery at University College London, along with 12 other doctors, writing to 476 primary care trusts urging them to discontinue the funding of complementary therapies. Never mind that an estimated 50% of GPs recommend their patients for complementary treatment, these 13 people clearly believe they have the right to dictate national policy on the matter. Signatories to the letter include Nobel Prize-winner Sir James Black, Sir Keith Peters, president of the Academy of Medical Science, and Edzard Ernst, the UK’s first “professor” of complementary medicine. The letter describes homeopathy as an “implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness”.

Seems these august gentlemen have got their facts just a little bit wrong here, which ought to royally backfire on them, but probably won’t because so few people bother to read beyond the sensationalist headlines and examine the data on which the conclusions are based. For example, linked from this article on the BBC’s website, is one from November last yearpublicising the Bristol Homeopathic Hospital study in which 70% of 6,500 patients reported positive health changes with homeopathic treatment. The article mentions last year’s Lancet meta-analysis, saying:

“The Swiss-UK review of 110 trials found no convincing evidence the treatment worked any better than a placebo.”

Again, factually incorrect. The review gathered a total of 220 trials for examination, but its conclusions were based solely on a comparison of just 8 homeopathic trials (selected from a total of 110) with 6 conventional medical trials (out of a total of 110). 8 undisclosed trials at that, making it impossible to determine whether what was being measured even falls within an acceptable definition of “homeopathy”. Further, the authors of the study declared their bias from the outset. They believed homeopathy to be placebo and there appeared to be no attempt to do any more than support that opinion. The quality of this study has been so widely condemned by serious academic scientists that it prompted the following comments from Mikel Aickin PhD, Research Professor at the University of Arizona:

“The Lancet article appears to be part of a recent trend, in which medical journals are publishing articles of exceedingly low quality to justify attacks on controversial therapies.”
[...]
“There is unsettling evidence that we are now in the midst of a methodological degeneration in biomedical science. This appears to be occurring in, of all places, our fundamental approach to inference – using observation and evidence to decide how to act or believe. That it might be happening in medical research makes it of more than just academic interest.”
(Aickin, Mikel. The End of Biomedical Journals: There Is Madness in Their Methods. Journal of Alternative and Complementary Medicine Oct 2005, Vol. 11, No. 5: 755-757)

(For a more detailed exposé of the Lancet study and the wider context in which it was produced see my post from March 18 and Myths and Misconceptions about homeopathy, both on this site.)

Edzard Ernst is quoted in the BBC article as saying, “I believe we need one single standard in medicine and that is the standard of evidence based medicine.” Indeed. Couldn’t agree more. Perhaps these 13 devotees of evidence-based medicine should take a closer look at their “evidence” before pontificating so loudly and publicly? If we’re to take their conclusions as representative of the quality and rigour of scientific investigation found in the upper echelons of the medical elite then biomedical science is, as Mikel Aickin suggests, in very deep doodoo.

Several news websites are conducting polls based on this letter. If you would like to take part, try:
BBC
Sky News
Daily Mail

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Curative amnEASYa

Tuesday, January 3rd, 2006
Dr Christian Friedrich Samuel Hahnemann (1755-1843). Image W Howard

Samuel Hahnemann, the founder of Homeopathy

“The highest ideal of cure is rapid, gentle and permanent restoration of health, or removal and annihilation of disease in its whole extent, in the shortest, most reliable, and most harmless way, on easily comprehensible principles.”
Samuel Hahnemann, Organon of Medicine, 1842

A while back I was talking to a colleague who was expressing frustration and incomprehension at how it is that even people who’ve had some of her best and most successful homeopathic prescriptions still go running back to their MDs/GPs next time something’s amiss, and only come back to her after a series of prescriptions have failed to address the problem and it’s become more intractable in the process. It’s probably something that most homeopaths have experienced at one point or another, at least in countries where the biomedical model predominates, and it does seem a bit puzzling.

After all, the best prescriptions fulfill all Hahnemann’s criteria (left) for cure which, by general standards, are pretty stringent. Surely something so comprehensively effective would impress even the most hardened sceptic and be enough to elevate homeopathy into the position of first choice when it next became necessary to seek medical attention, as well as providing just the sort of data evidence-based medicine requires? Not so in every case, it seems. So what’s happening here?

It’s something I’d thought about off and on until I had first hand experience just before Christmas which threw a spotlight on the issue.

I started to come down with a succession of symptoms which told me a major cold was on its way. I get one every 2-3 years and this one felt like it was shaping up to fairly monstrous proportions. First there was the cold sore, then the loss of energy and vague nausea, then the sinus headaches with that peculiar pregnant sensation in the sinuses which warns you that in a few hours’ time you’re going to be drowning in exceedingly large quantities of catarrh. Usually I somehow manage to forget to treat myself, but on this occasion the prospect of being floored by a bad cold in the run-up to Christmas with all the school plays, carol services, choir concerts, shopping, etc, etc, was enough to get me out of bed (where I was trying unsuccessfully to sleep off the sinus headache) and onto the computer to run my symptoms through the remedy-selection process. The remedy was blazingly obvious – just as well since I could barely see straight, let alone think. I took a single Phosphorus 200C, crawled back into bed, and promptly fell asleep.

When I woke up a few hours later, the headache had gone and so had the pregnant sinuses. I made myself a hot drink and got an early night. By the next morning I was back to normal and even the remnants of the cold sore had disappeared. My state had completely changed and I just got up and on with my life as if nothing had happened. It took me a full 12 hours to get round to thinking about how I’d been feeling the previous day, at which point I was marvelling at my lucky escape, and another few hours after that to finally remember that I’d taken a remedy for it!

Clang! The penny dropped. If even a homeopathic practioner had been capable of forgetting that she’d taken a remedy and experienced the highest ideal of cure, what hope was there for those whose lives don’t involve living and working with homeopathy on a daily basis? It had all been just too easy. My state had changed. There was nothing that remained to remind me of the previous state I’d been in and therefore it simply didn’t impinge in any way on my consciousness.

Then thinking back to other times when I’d managed to get it together to find a remedy for myself in similar acute situations, I realised there had been a fair few such occasions. There was the time when I’d been very much under the weather and had dreamed of meeting an old and respected figure from homeopathic history who told me to take Rhus toxicodendron! I was highly sceptical (even though describing my state as “under the weather” should have rung peals of bells had I been in any state to think), but when I looked up my symptoms, it was the indicated remedy. It worked brilliantly.

So why, with all this good and powerful experience under my belt (not to mention the number of times I’ve witnessed it in action in others) doesn’t it instantly occur to me to treat myself homeopathically whenever I fall ill? Perhaps it has something to do with Michel de Montaigne’s assertion (below), and with the fact that under stress we tend to revert to knee-jerk conditioned behaviour rather than a plan of action derived from an intelligent assessment of past remedial strategies. For those who’s conditioned reaction is to go consult their GP/MD, then that’s what they do.

“Nothing fixes a thing so intensely in the memory as the wish to forget it.”
Michel de Montaigne (1533-1592)

This “curative amnesia” also seems to be reflected in the number of patients who never return for follow-up consultations after first coming to a homeopath. When I first started in practice, I used to think all the non-returners were my dismal failures, but many of them subsequently came back months, sometimes years later to report that they simply got better and forgot all about their return visits. (This is something that no doubt a lot of homeopaths will recognise.) After realising this, I took to making it plain to people that they didn’t need to worry about coming back if they got better, but that it would be very nice to know they’d got better. It hasn’t made an ounce of difference. Once consciousness of the state disappears, it disappears.

Experiencing it for myself first hand like this brought to mind J T Kent’s (a well-known 19th/early 20th century homeopath) comment about symptoms being essentially something that impinge on our awareness (unfortunately I can’t lay my hands on chapter and verse right now). Also brought to mind an article I’d recently read which threw into sharp relief just how little of our existence and behaviour is governed by our rational intellect (see the articleUnscientific Attachment for another angle on this):

“Burgeoning understanding of our unconscious has deeply personal and also fascinating medical implications. The realization that our actions may not be the pristine results of our high-level reasoning can shake our faith in the strength of such cherished values as free will, a capacity to choose, and a sense of responsibility over those choices. [...] According to cognitive neuroscientists, we are conscious of only about 5 percent of our cognitive activity, so most of our decisions, actions, emotions, and behavior depends on the 95 percent of brain activity that goes beyond our conscious awareness.”

Just 5%. Leaving 95% not only unexplained but unregistered. So much for our precious intellect. In this context, the much-vaunted aims of evidence-based medicine do start to look a little less glowingly straightforward than they might first appear.

“The poets did well to conjoin music and medicine, because the office of medicine is but to tune the curious harp of man’s body.”
Francis Bacon (1561-1626)

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DISCLAIMER
Thanks to the current insanity revolving around homeopathy in this country, in both media and blogosphere, it's become necessary to insult your intelligence by explicitly drawing your attention to the obvious fact that any views or advice in this weblog/website are, unless stated otherwise, the opinions of the author alone and should not be taken as a substitute for medical advice or treatment. If you choose to take anything from here that might be construed as advice, you do so entirely under your own recognisance and responsibility.

smeddum.net - Blog: Confessions of a Serial Prover. Weblog on homeopathy, health and related subjects by homeopathic practitioner Wendy Howard