Bogus arguments for unproven treatments
Many unproven or disproven treatments are currently popular (1). The reasons for this popularity are complex, (2) but incessant misinformation of the public is likely to be a crucial contributing factor (3). There are millions of websites dedicated to one sort of alternative medicine or another; most of them are commercially motivated and dangerously misleading. Our bookshops are full with volumes on alternative medicine, most of which are a risk factor to our health (4). Women’s magazines tend to provide uncritical information that put their readers at potentially serious risk (5). Even seemingly respectable organisations mislead the public (6). In the UK, the newly founded ‘College of Medicine’ (7), for instance, is fast becoming a prominent source of dangerously misleading information (8,9).
Here, I will briefly outline six false or misleading arguments frequently employed by advocates of unproven treatments. As an example, I have chosen homeopathy, as it is a treatment used by many patients worldwide (1), its principles are biologically implausible (10) and the clinical evidence fails to show that it is effective beyond placebo-response (11). The claims and arguments of homeopaths are similar to those of other providers of alternative medicine. In the following discussion, homeopathy could therefore be exchanged with acupuncture, chiropractic, naturopathy or any other alternative therapy.
Patients are whole individuals
As the ‘College of Medicine’ puts it, humans ‘are more than just physical bodies’ (7). Homeopaths stress that they view every patient as a whole, complex individual requiring care for the body, mind and spirit (12). In the view of its proponents, this attitude renders homeopathy an ‘appropriate’ therapy (13). In fact, the ‘College of Medicine’ prominently showcases homeopathy as an example of ‘good medicine’ (7).
All good medicine was, is and always will be holistic (14,15). The fact that patients consist of body, mind and spirit is taught to every first year medical student. Social medicine, psychiatry, psychology etc. are mainstream disciplines. To practice holistic healthcare, we do not need homeopathy or other unproven therapies. In areas where healthcare might be neglecting holism, we need to reform it – but not through ‘a complete paradigm shift’ (8) or by introducing quackery.
We must treat the causes of illness
Treating the symptoms of illness does not reflect the ‘complex causality of the real world’ (12). Homeopaths claim to treat the causes of the problem and accuse conventional doctors of merely alleviating symptoms. Patients tend to regard causation of illness as a priority for good healthcare (16). A homeopath exposes layers and layers of symptoms until finally, the root cause becomes recognisable. Only then can true healing commence.
Finding the cause of a disease is undoubtedly important; nobody would ever deny it. However, this process requires plausible concepts of causation rather than the implausible notions such as the ‘like cures like’ principle (10). Illusions of causality are at the heart of pseudoscience (17). Much of the efforts of mainstream medicine are, in fact, focused on discovering the causes of disease. Whenever possible, the therapeutic approaches of conventional physicians aim at the causes of disease, whereas homeopaths tend to ignore them.
We must appreciate the burden of chronic disease
Many chronically ill patients are currently not treated effectively by conventional doctors who tend to prescribe drugs that merely alleviate one symptom (e.g. rheumatic pain) and cause another, often much more serious problem (e.g. gastrointestinal bleeding). Homeopaths, on the other hand, appreciate the ‘limitations within the conventional healthcare system’ (18) and, in particular, aim to alleviate chronic suffering (12). Mainstream medicine’s failure to address the chronicity of disease is, according to the ‘College of Medicine’ akin to ‘mopping the floor when the sink is overflowing’ (7).
All medical interventions must be measured with the same yardstick. Only if a therapy demonstrably generates more good than harm, can it be considered for routine practice. This general principle applies regardless whether we are treating an acute or a chronic condition. Conventional doctors certainly know about the importance of chronic disease and suffering. Consequently, they use all effective treatments to ease this burden. Good mainstream medicine is aware of its imperfections and aims to change them for the better. The adoption of unproven treatments can only render healthcare more imperfect than it already is.
Prevention is paramount
Mainstream medicine is capable of doing decent ‘repair jobs’ but, when it comes to avoiding health problems from occurring in the first place, it is often woefully inadequate. Homeopathy, on the other hand, has a focus on the preservation of health and wellness (19). The ‘College of Medicine’ certainly puts great emphasis on the importance of disease prevention for ‘good medicine’ (7).
Preventive medicine is a well-established, mainstream specialty. All effective measures of disease prevention known to date originate from conventional medicine and science. Homeopathic treatments have not been shown to prevent a single condition, and the contribution of homeopathy to disease prevention is nil. Some homeopaths even campaign against effective preventive measures such as immunisations (20).
Patient choice is the ultimate arbiter
Homeopaths frequently claim that conventional healthcare professionals neglect patient choice. Therapeutic decisions, they insist, must be taken in partnership between the patient and the clinician, and the patient invariably has the last word! Homeopathy is currently popular (1). From this phenomenon, homeopaths tend to conclude that patient choice demands that individuals who want homeopathy must be able to use it (21).
Patients’ right to choose is firmly anchored in all areas of medicine (14), and patient-involvement in clinical decisions can improve outcomes (22). Informed consent is a cornerstone of medical ethics. However, choice that is not informed by reliable advice can be problematic and dangerous. As there is no good evidence for homeopathy (11,23), reliable advice would not work for but against it. Advocating homeopathy in the name of patient choice is therefore nonsensical.
Evidence is not everything
Homeopaths are keen to point out that much of conventional healthcare is not evidence-based (24)]. ‘Nearly half of all current procedures would have to be withheld until expenditure of much time, money and effort had firmly ‘proved’ their effectiveness’ (25). Insisting on evidence for homeopathy is therefore unfair and discloses anti-homeopathic bias. The ‘College of Medicine’ thus advocates ‘a fundamental shift in our way of thinking about the relationship between evidence, information from scientific research, expertise, reasoning, clinical knowledge, and good practice’ (7).
Sadly, it is true that many conventional treatments remain unproven (24). However, this is precisely what evidence-based medicine aims to remedy. The existence of evidence gaps is no reason for introducing homeopathic placebos (26,27). This would only introduce double standards, widen the gaps and contravene our duty to render future healthcare more evidence-based.
The proponents of unproven treatments such as homeopathy frequently use arguments which, on the surface, may seem compelling (28). On closer inspection, many of these arguments turn out to be classic examples of a misinterpretation of the opponent’s position. Patients and policy-makers can be misled into feeling that the integration of unproven therapies offers the ‘provision of patient-centered, effective and safe healthcare’ (29). However, in reality, ‘integrative care is attempting to lift core attributes of normal good care away from the norm and into their special realm, spiced with placebo pills and acupuncture, which inject the consultation with inherent truths’ (30). If we allow ourselves to be hoodwinked in this way, we are bound to waste valuable resources (31) and fail our duty to provide the best available care for our patients.
No conflicts of interest.