Exeter, Devon UK • Dec 11, 2023 • VOL XII

Exeter, Devon UK • [date-today] • VOL XII
Home ScienceHealth A Placebo … For the Public?!?

A Placebo … For the Public?!?

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In a recent event run by the University of Exeter’s Debating Society (DebSoc), I had the pleasure of arguing the proposition side for the debate “This house believes that complementary medicine is a threat to public health”. It was a close thing, tying up at 34 to 36: we lost by two votes. But fear not, this piece will not just be a rendition of the debate, but rather some personal thoughts about what I learnt from arguing a scientific position on a public stage.

Much like theories are refined or disproved by the discovery of new evidence, arguments can only improve when subject to conflict; and understanding how the public views science is more vital now than ever. With Trump currently backing out of the Paris Agreement, and over half of American adults either showing scepticism or simply disbelieving in climate change, we now have to ask how, in this modern age, we can use scientific fact to change public opinion and policy.

unproven complementary medicine has no place in the publicly funded and promoted medical sphere

Complementary medicine is the use of non-mainstream practices alongside the application of those medicines proven and accepted by the wider scientific community. It does not include marijuana (our first question from the audience covered this matter) because I doubt that your doctor will refer you to a local drug dealer – weed, unfortunately, is still not offered on the NHS – but they may refer you to a homeopath, acupuncturist, or chiropractor.

Studies have shown treatments given by these practitioners to offer no greater or very little benefit above a placebo. The placebo effect should definitely not be underestimated and could arguably have a role to play in the future of modern medicine, yet the use of complimentary and alternative medicine (CAM) as that placebo is potentially harmful.

A great deal of this comes from CAM making unsubstantiated claims about science and health. Homeopathy, a popular form of CAM, includes the idea that the more you dilute a substance within a solution the more powerful it becomes, which stretches so far that in the majority of homeopathic treatments it is practically impossible for any active ingredient to be present. To combat this idea, many homeopaths argue that water has a memory. Our opposition on the night admitted that whilst they “don’t know how it works”, its function could be discerned from future discoveries in quantum mechanics (after admitting, themselves, that they know very little about physics).

Even though there are no repeatable experiments to back up these views, and their concepts fly in the face of all known science, I have to ask: what’s the harm of this? A far more worrying aspect of homeopathy is its main tenet of ‘like cures like’. This was established when the founder of homeopathy, Samuel Hahnemann, consumed cinchona bark and later thought he expressed malaria-like symptoms. He reasoned that if the substance were to be diluted, then it would be able to treat malaria upon being ingested.

This is still prescribed by homeopaths for this condition today, but what frustrates me (apart from the fact that it doesn’t work) is that it tells us nothing about the true cause of the disease – plasmodium parasites – but instead gives a wishy-washy concept of treating symptoms with symptoms. Such misinformation is anything but constructive in the long-term, and will certainly not lead to a greater public awareness of the basic concepts of science and health.

We wouldn’t be having this debate if homeopathy had been found to work, but meta-analyses – where data from lots of different trials are brought together and analyzed – have shown time and time again that homeopathy is no more effective than a placebo. There was some conjecture from the opposition over which of these to look at (with Dr. Malcom Wallace stating at one point, quite falsely, that only 5 had been carried out), but the fact remains that the only time homeopathy performs better is when the data includes poor quality studies.

Perhaps these practitioners are just misinformed, but in that case they shouldn’t be giving medical advice.

Incidentally, focusing on the errors in these studies proved to be a key error of mine in the debate: I wasted time trying to disprove CAMs, rather than looking at the wider social problems they cause. The consensus is clear within the medical community, and this is all I should have referred to; the House of Commons Science and Technology committee and the British Medical Association have both called for the government to stop the funding homeopathy on the NHS on the grounds of it not being “evidence based” since 2010.

Even so, up to last year the NHS was spending around £5 million annually on homeopathy. Some would argue that this is nothing compared to total NHS spending, but £5 million is enough to pay for 200 nurses and 50 consultants, an expense which would produce scientifically asserted results.

The real harm caused by CAMs is that unsupported beliefs left unabated lead to more unsupported beliefs, and this is something that homeopathy has a deep and rich history of. The first example I used was the charity Cancer Active, that describes itself as “the UK’s number 1 Complementary Cancer Charity”; which republished an article in 2012 that claimed that homeopathic remedies had been found to be just as effective as chemotherapy, and that thousands of cancer cases were being reversed by homeopathy alone. Seeing as people may have died from being misled like this, it’s somewhat painful to know that taxpayers’ money was going to this organization.

In dicussing individual deaths, the opposition commented that these were, for the most part, due to the people choosing to spurn their conventional treatments because of what they’ve read online rather than the advice from CAM specialists. This, however, denies further evidence of homeopathy being presented as superseding conventional medicine: a study carried out in 2002 showed that over half of UK homeopaths contactable by email advised parents against giving the MMR vaccine to children over fears that it causes autism.

This led to some debate as to whether they were justified to give this advice, with the opposition asserting that there wasn’t enough evidence at the time to know whether the vaccine was safe, and us, the proposition, holding firmly that 12 anecdotal stories – which made up the paper that started off the MMR hoax in 1994 – were never enough evidence to infer a link between autism and the vaccine. Looking back, the media latching onto ‘fake news’ was the main cause of the whole health scare and plummeting vaccination rates, and the general populace are still confused about the matter.

Placebo Extreme. Source: Flickr

However, an investigation carried out by Sense About Science in 2006 shows something that is more systemic to homeopathy, meaning it would of been a better example to use, as it uncovered that out of all the homeopathic practices they went to, 10 in total, not one recommended conventional medicine to combat malaria but proposed homeopathic treatments instead. Homeopathy will do nothing tangible to treat malaria, cancer, or any other serious illness; but what we see time and time again is a community that promises exactly that.

Simply put, the vast majority of CAM practitioners are not doctors, and can easily miss a diagnosis for a fatal condition. Be that as it may, it’s apparent that even when a sizeable portion know what the condition is or what their patients will be facing, they still rely on ‘alternatives’ rather than giving effective care. Perhaps these practitioners are just misinformed, but in that case they shouldn’t be giving medical advice.

Nonetheless, I assume some of the more well informed of you are asking: “What about using it for minor complaints like back pain and colds? How is that a threat to public health?”, and anyone who hasn’t is unaware of the actual power of the placebo effect. It has been found by comparing control groups from separate studies that four sugar pills are more effective at decreasing the size of gastric ulcers than two; and even a pill’s packaging or color will alter its effects.

What’s great is that you don’t even have to lie. This was shown in a randomized trial where even when doctors told women with irritable bowel syndrome that they were receiving sugar based placebo pills, the pills still worked – there was a 29 per cent greater report of adequate relief in the placebo group compared to the no-treatment control.

Unfortunately, something that plagues both CAM and conventional medicine is the idea that people deserve to feel better. Sometimes you can’t cure pain, and a lot of the time it’s best not to: the estimated 5.2 million people that went to their GP for blocked noses last year, and another 40,000 for dandruff, act as evidence for this. I have no doubt that prescriptions and waiting times on the NHS would go up with a standardised medical placebo. All the same, there are risks involveds with the idea of ‘hiding behind a pill’.

we can use scientific fact to change public opinion and policy

In many cases, what we need to be telling people is how to self-manage pain rather than duping them into good health and medicalising their conditions. Although CAM practitioners sometimes give sound advice, they do this whilst creating a culture where people believe you can suddenly become better through a detox, a needle in the back, or some special water. They propose ‘life hacks’, and in doing so give them greater prominence than actual therapy and lifestyle changes, such as stretching, exercise, and a consistent diet.

These may seem like inane suggestions – but isn’t it more patronising to allow people to waste their money and time on treatments that aren’t particularly effective, on the basis of ‘it makes them feel better because they don’t know better’? CAM’s longevity essentially relies upon the idea that it would be more beneficial for people to know less about science and about how to maintain their health, and blindly place their treatment in the hands of unproven and ineffective practices. Such a decision may suit the ideals of some, but I will always uphold a more well informed nation.

Therefore, unproven complementary medicine has no place in the publicly funded and promoted medical sphere.

If you want to read more science and a little lighter placebo debunk click here where Hannah Kitt sets the record straight on hangover cures!

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