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The backbone of modern medicines success has long been attributed to an evidence-based paradigm; a direct point of difference when compared to the practices of homeopathy. In medicine all diagnoses and subsequent treatments are informed by a plethora of scientifically proven and reproducible studies (1). Under this paradigm, any form of treatment may be used for a given health related issue, as long as its mechanism of action can be explained and recapitulated scientifically. While some alternative medicines fit under this model, one which does not is homeopathy. A discipline whose remedies and treatments are omnipresent in pharmacies and the like, resulting in an excess of 4.4% of Australians over the course of a typical year (2). Whilst the argument against homeopathy may be made on a solely scientific basis, as attempted by the NHMRC which emphatically states that there are no health conditions for which there is reliable evidence that homeopathy is effective (3). The debate may be extended into the plains of reason and ethics, particularly as homeopathic proponents are typically quick to dismiss any scientific critique.
The basis of homeopathy arises from the premise that like cures like, whereby one may be cured of a variety of ailments through the consumption of a remedy consisting of numerous diluted substance (4). Despite these remedies having no proven mechanism of action in any illness which they have been tested under, homeopaths continue to dismiss any concern surrounding the lack of a tangible scientific evidence (5). Instead, vaguely proposing that a mechanism of action does exist and has simply just not been discovered yet (6). The implications of this ad hoc speculation is not only misleading, but implies that our current grasp of science is insufficient to understand a discipline devised nearly 200 years ago. A dangerous inference to make, as it risks casting doubt over a sound paradigm which has been carefully cultivated over years. While, homeopaths may be unwavering in this scientific debate, if one is to extend the same argument to the realm of ethics the true insufficiencies of their argument is exposed. If the desired outcome of these homeopathy proponents is for their remedies to be considered equally justifiable in the use of the treatment of illness as true medications. Then it would follow that any application of homeopathy should be subject to the same level of scrutiny that would be applied to any other practice of medicine. This would then mean that homeopathic practitioners would have to practice in accordance with the best available knowledge, as is expected of any other medical physician. Granted that the best knowledge is unanimously agreed to be provided by science (7). It then follows that any prescription of a homeopathic remedy which is null of scientific support, would be in direct violation of a foundational principle of medicine. To avoid this critique homeopathy would consequently need to be considered as a non-medicinal discipline. However, in doing so would mean that any practise of homeopathy in a clinical setting or claims of efficacy for a given ailment of any severity, would be considered mass deception. Something which ethically is considered innately wrong under Kantian ethics, as well as being in opposition of producing the greatest possible good for greatest number of people under utilitarianism.
Following the rationale that homeopathy as currently constructed is unable to scientifically or ethically constitute as a medicine under the paradigm of evidence based practice. Some have suggested for homeopathy to instead be applied in medical situations as a placebo-based therapy (8). A notion which builds off the current scientific understanding of homeopathy as it is believed that all reported efficaciousness of their products can be attributed to the placebo effect. Proponents of this shift in the discipline call for the substitution of the remedies for placebos such as flavored water (9). With the hope that the placebo effect of homeopathy will be retained, whilst removing the risk of giving a potentially toxic remedy if it hasnt been sufficiently diluted. While the placebo effect has been proven to produces tangible and reproducible effects, this framework would still be unacceptable on ethical grounds. The current ethics for the application of placebos is still under intense debate for any forms of use, including informed use of a placebo. This proposal would imply a direct breach of the ethical imperative to facilitate informed consent and moreover autonomy, as it would involve the hoodwinking of patients to facilitate the placebo effect. While this idea may seem outlandish and would be met with almost complete rejection by homeopathic practitioners, it allows for a light to be shone on a distinction which must be allayed in the ethical debate and perception of homeopathy.
Whilst there is no scientific evidence, most homeopathic practitioners do believe that their products are efficacious and in doing so are acting in good faith (10). Despite this not being sufficient to absolve homeopathy of the whole of being unethical in its application, the suggested shift in homeopathy to placebo-based therapy insinuates that practitioners are not acting in good faith. Instead claiming that practitioners lying to their patients about the constitution of their remedies would be no change to what currently do. Thus, while ethically and scientifically the outcomes of this shift are still insufficient to apply to any medical context, one must be careful of mischaracterization of the actual practitioners in this discourse.
Given this total failure to find a scientifically viable application of homeopathy, the natural conclusion would be to bring an end to homeopathic remedies in any medical related context. Before this judgement maybe made, the final argument which must be deliberated, is whether a ban against homeopathy would be paternalistic and contravene the autonomy of patients who willingly choose homeopathic remedies (11). While superficially this argument may seem to have merit, the argument is fatally flawed. Since, for one to act autonomously there must be truthful provisions of efficacy and risk provided (12). Following that neither of these can be produced through any scientific evidence, one cannot make an ethically sound autonomous decision. Instead any decision made by a consumer would be based on fabricated and misleading promises made by those distributing the homeopathic product. While in many contexts this may seem a superfluous argument as individuals seeking these products do so due to having experienced a benefit from homeopathic remedies. The danger lies in the precedent that is set by tolerating these misleading and false claims. While it may seem innocuous in the context of treating headaches, the trust that consumers begin to build for the effectiveness of these homeopathic remedies becomes exploitable in other realms of healthcare where a placebo effect will not be enough to see recovery. No example highlights these risks more poignantly than the wave of homeopathic products currently claiming to protect individuals against the highly contagious and potentially fatal COVID-19 virus. While, few may buy the products, the claims made surrounding these products incipiently coalesces with the conspiratorial rhetoric against the current health advice. Thus, creating a space where through pseudo-science backing individuals believe they are within their rights to be non-compliant with the health advice. While this may seem to be speculative and inferential, the same pattern seen during this pandemic has played out several times in the past.
With an exemplar being the deplorable actions of Homeopathy Plus who falsified a homeopathic whooping cough vaccine. Whilst simultaneously spreading misinformation about the effectiveness of the genuine whooping cough vaccine that was available (13). These actions were found to be a breach of Australian Consumer Law and they were subsequently reprimanded. Despite the outcomes of this trial, the repetition of this behavior by the discipline in this current pandemic highlights the importance of discourse needed around homeopathy. As in the context of a pandemic particularly the false claims made may not only risk the lives of the individuals who take their products but also extend to many others around them.
In conclusion, the debate the value of homeopathy as a medical practice is intrinsically flawed, as if one wishes to practice homeopathy it would have to be through the rejection of not only scientific fact but the rejection of any ethical consideration. Due to the inability of the discipline to be shifted ethically to a placebo-based therapy framework, the only logical deduction would be to prevent use in any medical context or face the risk of it continually infiltrating aspects of medicine which may cause incomprehensible damage both directly to ones health or indirectly on a societal level.
References
- Sackett DL, editor Evidence-based medicine. Seminars in perinatology; 1997: Elsevier.
- Relton C, Cooper K, Viksveen P, Fibert P, Thomas KJH. Prevalence of homeopathy use by the general population worldwide: a systematic review. 2017;106(2):69-78.
- Health N, Council MR. NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions: National Health and Medical Research Council; 2015.
- Smeaton JJJoCMC, The. Homeopathy. 2002;1(3):38.
- Milgrom LRJCMR. Under pressure: Homeopathy UK and its detractors. 2009;16(4):256-61.
- Levy D, Gadd B, Kerridge I, Komesaroff PAJJoBI. A gentle ethical defence of homeopathy. 2015;12(2):203-9.
- Djulbegovic B, Guyatt GHJTL. Progress in evidence-based medicine: a quarter century on. 2017;390(10092):415-23.
- Smith KR. Why homeopathy is unethical. 2011;16(3):208-11.
- Hahn RGJCMR. Homeopathy: meta-analyses of pooled clinical data. 2013;20(5):376-81.
- Smith KJB. Against homeopathya utilitarian perspective. 2012;26(8):398-409.
- ZawiBa-Niedzwiecki J, Olender J. A Not-So-Gentle Refutation of the Defence of Homeopathy. J Bioeth Inq. 2016;13(1):21-5.
- Coggon J, Miola JJTClj. Autonomy, liberty, and medical decision-making.2011;70(3):523.Word count: 1419 Student Number: u7088750
- Sieverson D. Court imposes penalty for false or misleading claims by Homeopathy Plus and Ms Frances Sheffield. Australian Competition & Consumer Commision 2015.
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