Ernst Praises Hahnemann?

Resident MSS Doctor and Skeptics in the Pub goer Selva shares his views on Edzard Ernst and Samuel Hahnemann…

In a recent Pulse magazine article professor of complementary medicine Edzard Ernst praised the founder of homeopathy, Samuel Hahnemann.

“In my view, Samuel Hahnemann, the German doctor who invented homeopathy about 200 years ago, is a man who should be celebrated.”

Can this be true? Surely one of the most respected proponents of evidence based medicine cannot be advocating homeopathy as a treatment.

In his article he cites the hammering homeopathy has received over the last year including the House of Commons select committee’s damning report, the BMA describing homeopathy as “witchcraft”, and my particular favourite – comedians taking the “homeopathic mickey” (sadly 10.23’s not insignificant role doesn’t get a mention).

Fortunately normal service resumes further in the article – to quote Prof Ernst:

“His primary achievement is not to have developed homeopathy. His true achievement is that, in the course of doing this, he has shown us how important non-specific effects – often also called the ‘art’ of medicine – are in terms of getting patients better. To put it bluntly, Hahnemann has taught us that patients can improve even when we give them nothing but placebos.”

This somewhat conciliatory line is admirable, but I think also provides the crack which has allowed homeopathy to be practiced for so many years as an NHS treatment. Most doctors either haven’t been aware of the implausibility of homeopathy, or have been happy for other practitioners to provide placebos to patients, in the knowledge that there is some perceived benefit. Homeopathy is often given for intractable problems, where EBM doesn’t always provide sufficient benefit. As Prof Ernst says, the act of being empathic and providing sufficient time is often enough to make the patient feel better.

I agree with the professor on the benefits of offering empathy and time, but I don’t believe this is the entirety of what homeopathy offers. Firstly it requires a degree of dishonesty on the part of the clinician who either is consciously giving a placebo treatment, or is deluding himself that there is efficacy in the homeopathic treatment. There is also a degree of collusion between practitioner and patient, where both may be aware of the lie, but have to go through the ritual, in order for the placebo effect to work. This ritual extends to the ridiculous dilution and succussion process.

The degree of self delusion is apparent in the responses to Prof Ernst’s post. One homeopath writes:

“a medical system that has spread to all continents of the world through little more than word of mouth- ie the recommendation of satisfied patients- to the point where it is now the second most widely used medical system in the world’ I think these … qualifications speak for themselves for it is a ludicrous supposition that homoeopathy could have gained such widespread approval on the strength of nothing more than the placebo effect.”

No need for evidence here then, just lay on the self delusion with a trowel. Further on he states:

“I believe it is part of the code of ethics of doctors in this country that they do not publicly decry fellow professionals. The fact that some junior members of the BMA broke their own code in order to criticise fellow doctors who have undergone full professional training then undertaken further training in order to become members of the Faculty of Homoeopaths should be deplored and is certainly evidence of a lowering of professional standards.”

This last point is especially sad, as the junior doctors were not criticising specific homeopathic doctors, but the entire implausible tenet that they depend on.

Hats off then to Hahnemann for helping to expose the placebo effect, which through double blinded placebo controlled trials can be dialled out of the equation. The short term gains achieved by being dishonest with patients cannot be helpful in the long run. Despite time constraints, I would hope that doctors would always provide empathy and sufficient time required to deal with their patients. Providing an explanation of their condition, and being honest about what can (or cannot) be done to help them is much more laudable, empowering and ultimately more beneficial.

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  1. #1 by edzard ernst on June 23, 2010 - 09:33

    it would be a misunderstanding of my article to say that i condone homeopathy.the opposite would be closer to the truth.i was merely pointing out that homeopathic remedies are placebos,that the therapeutic relationship is important, and that the latter explains why so many patients are convinced of homeopathy.

  2. #2 by Sel on June 23, 2010 - 15:09

    Thank you for responding to my article. I am aware of your position on homeopathy, and was essentially agreeing with the points you raised, particularly regarding Hahnemann unintentionally raising awareness of the placebo effect. I also agree that the therapeutic relationship is extremely important – Balint’s “doctor as the drug”.My added proviso was that though homeopaths offer the positive aspects of time and empathy, there is also a degree of dishonesty and collusion, which ultimately is not helpful.

(will not be published)