After several decades of increasing popularity, the homeopathic community is finding itself under growing pressure. There is an increasing level of criticism of the practice coming from many quarters, including Richard Dawkins recent Channel 4 programme, lots of bloggers and academics too.
Importantly, homeopathy is not being seen as as benign as its adherents’ propaganda suggests and that there are real dangers in the belief in magic water and sugar pills. It’s not all bad news for homeopaths, there is unexpected support in some quarters. So, why is there so much pressure on them at the moment and where will this leave the homeopaths in the UK? More importantly, what should homeopaths being doing if they want to survive in any meaningful and respected way?
To make an attempt at answering this question, we need to understand a little history of homeopathy in the UK. The man considered responsible for introducing homeopathy into Britain was a Dr F H F Quin. He first starting touting his remedies in the 1830’s, and being of aristocratic origin, his patients were the upper classes and nobility of British Society. He was keen to keep homeopathy within the medical profession and with the high paying aristocracy.
Another strand of homeopaths emerged in the wake of the ever increasing regulation and scientific nature of the medical profession. Lay homeopaths started emerging in the later half of the 19th century. These practitioners were not medical qualified and were from the start associated with more radical approaches to homeopathy. Despite offering their services to the lower echelons of society, radical lay homeopathy found it difficult to gain a foothold and homeopathy never really achieved mass popularity like it did in other countries.
The twentieth century saw the reversal of this picture with medical homeopaths in decline and lay homeopaths in ascendancy. The vestigial remnants of institutional medical homeopathy are now mainly centred within a few remaining homeopathic hospitals, and interestingly, they still have their aristocratic ties. Dr Peter Fisher of the London Homeopathic Hospital is proud to be called the Queen’s physician. Homeopaths see this as a big stamp of approval for their quackery, although the HRH support says more about our royals than about the efficacy of homeopathy. When did we last see a Prince of the Realm educated in a science subject at university? We are much more likely to see them being trained in history, agriculture and how to kill foreigners.
But of course, the shocking thing is that homeopathy and these hospitals are funded by the NHS. It is a bit like finding a room in the cellars of a modern city hospital that still had working tanks for breeding leeches. This ghost of Victorian patriarchal medical quackery lurking within a modern public health service is of course an absurdity, and this is increasingly being pointed out both by senior academics and medics and the hospital managers who want to spend their limited budgets as wisely as possible. Medical homeopaths recognise the threat and are trying to campaign to save their funding. Even with their attempts to court members of parliament, it would look likely that those tasked with spending NHS money will make medical homeopathy an interesting modern historical anomaly. NHS Homeopathic hospitals are doomed by the simple asymmetry of their position. Stopping funding and closing hospitals is a fairly easy decision to make. Arguing for increased homeopathic provisioning and opening new hospitals looks almost impossible in today’s climate. Would you want to argue for massive increased funding of contentious, unproven quackery in front of parliament? No, medical homeopathy will dwindle and die and be left with just a few GPs dabbling on the side.
That leaves the question of the future of lay homeopathy. Although somewhat antagonistic towards each other, lay homeopaths depend on their dwindling medically trained colleagues for a certain amount of credibility. However, lays have their own set of problems and these are mostly self-inflicted. Lays prefer to be called Professional Homeopaths as this gives them the appearance of, err, professionalism. However, their central problem is that they lack any sort of professional ethos whatsoever. Medical homeopaths are registered mainly with the Faculty of Homeopathy. However, they are ultimately accountable to their medical colleagues and can suffer severe penalty if they transcend their medical codes. Lay homeopaths are under no such sanction. This would explain the different attitudes of Dr Peter Fisher and his lay colleagues to the treatment of malaria with homeopathic pills. Fisher condemns the practice in the strongest terms whilst the Society of Homeopaths take absolutely no action to take their members to task over the widespread practice.
One could predict that without the constraints of either legislation, professional sanction or a commitment to rational enquiry that lay homeopaths will go off the deep end with ever increasing absurdity in their delusions. And that is just what we see. Not content with trying to treat a few headaches and grazed knees, their healing fantasies spread across the medical spectrum. Homeopaths take great pride in their work in ‘helping’ Africans with malaria or HIV. They proudly set themselves up as real alternatives to the medical profession and will tell their patients that. They splinter into factions with some saying that the only true homeopathy is that set out by Hahnemann whilst others take on more radical and ‘progressive’ approaches. Ever more ‘inventive’ remedies are produced from weird substances like hyena saliva, bewick swan and stone circles. Some are totally unconstrained and start believing they can make homeopathic mp3 files. Despite the various organisations that represent lay homeopaths expressly forbidding practices like these, no action ever appears to be taken. Homeopathic solidarity appears to be more important than constraining their members’ out of control actions.
Of course, there is debate about these issues between homeopaths. One remedy at a time? Or multiple remedies? But having rejected the normal standards of scientific evidence and methodology that would normally settle such medical disputes, there are no ways of reaching consensus and so the community settles into its little-enders and big-enders groupings. Science has to be rejected as when it is used it consistently shows all homeopathic flavours to be equally as deluded. There is equivalence in all homeopathic delusions. And without a rational approach and mindset, homeopaths are free to drift off into deep and dangerous nonsense, best exemplified by the recent scandals of their advocacy of treatment of malaria and AIDS. This is not fringe behaviour. The Society of Homeopaths, the biggest register of lay homeopaths in the UK, is holding a symposium in London in December on the treatment of AIDS with homeopathy.
Criticism of homeopaths is widely seen as a conspiracy of vested interests and pharmaceutical company evil that is ‘frightened of alternatives to their money making obsessions’. This is, of course, nonsense. Critics are just deeply concerned about the behaviour and consequences of the purveyors of unfettered nonsense setting themselves out to have healing responsibilities. This handy ready-made excuse of ‘Big Pharma’ prevents homeopaths having to think critically about what their detractors are saying. Few engage with the outside world and try to tackle their genuine concerns in a meaningful way.
There is, however, widespread recognition that they do need to get their house in order. There does need to be the appearance of a professional set of people able to look after their own affairs. Looking at other alternative medical practices, and seeing external regulatory pressures being put on them, homeopaths fear the consequences of either UK or European pressure to sort themselves out or restrict their activities. There has been a recent attempt to create a body that will oversee a single register of homeopaths as the first step towards a unitary self-regulatory body. However, the newly created body, CORH, recently collapsed with unpaid debts after some of the member bodies refused to pay dues and after widespread squabbling about what exactly homeopathy was. A new body is feebly trying to raise out of the CORH ashes, but the question of funding such a register is still undecided.
Regulation and legislation under the Blair Woo government has been lax and sometimes favourable. By giving fake pill manufacturers like Nelson’s the ability to sell sugar pills as treatments for named conditions like hayfever and teething pains, homeopathy certainly gained some credibility and some profits for companies like Boots. This is unlikely to be maintained or strengthened under less ‘new age’ governments and after the torrent of criticism directed at the MRHA on the issue.
Attitudes of both the public and regulatory bodies tends to be fairly neutral towards homeopathy. It is seen incorrectly as a form of herbal medicine by some, or a benign nonsense by others and so not worth wasting effort on. Homeopathy rather slips under the radar and is not seen as something that can cause harm. What direct harm is done appears to be exported to developing nations with huge health care problems. Pretending you can cure AIDS with magic water will, of course, kill people. But it is tolerated in the UK by a society that likes the anti-establishment nature of it and the supposed self-empowerment. Jeanette Winterson writes in the Times about her first publisher, Philipa Brewster’s attempts to export murderous delusion to Botswana without a hint of the controversy that such an action deserves.
Whether renewed UK or EU regulatory bodies wake up and take notice of homeopaths in the same way that they are curbing the excesses of vitamin pill sellers remains to be seen. What would be far preferable would be to see homeopaths take control of their own profession and reform it in meaningful ways. I must say that I see this as most unlikely as I cannot identify any leadership that could unite the majority of practitioners and take them towards a new vision. The depths of delusion, the resistance to criticism and the distrust of the wider medical community make my hopes rather futile.
But what sort of reform would be required? Well, there are perhaps a couple of levels of reform that could be made:
The first step would be to embrace the data. Just as the medical profession have spent the last five decades relinquishing their personal authority to the democratic pool of scientific evidence, so too homeopaths need to recognise that what they do is indistinguishable from providing placebos. That is what the data says, consistently. If homeopaths were to practice within the boundaries of that knowledge then almost all criticism would vanish overnight. Of course, homeopaths would have to start to understand placebos and let go of their more mystical notions of self-healing. Placebos have limits. Many complaints, and especially serious conditions, are not placebo responsive and so there would be no more dangerous nonsense about treating cancer, malaria or AIDS. Homeopathy could happily survive in a limited form if this was taken on board. At best, homeopaths could offer a lay complementary therapy alongside real medicine. At worse, it would be no different from any cranky new age crystal healer or aromatherapist. Maybe it would be just a bit of tolerated nuttiness.
The second and bigger step would be to fully recognise that the benefit that homeopaths give to their clients is all in the consultation. They are counsellors. Recognising this would mean abandoning the mumbo-jumbo of ‘like-cures-like’ and their crazy dilution/succussion rubbish. The homeopathic community represents a huge pool of people who are good at listening to people with health problems in a way that the GP cannot. Developing these skills, retraining and finding a way to integrate and exploit this pool would undoubtedly provide real complementary medical service within the UK, and almost certainly deserving of NHS funding.
They might not call themselves homeopaths anymore, but our society would benefit from a more rounded, effective, rational, caring, and, dare I say, holistic approach to health care.
And then pigs might fly.