The Agony of Choice

This blog is in response to this Early Day Motion, which essentially is in support of homeopathy in the NHS, and specifically to Caroline Lucas's signature, a politician whom I otherwise greatly respect.

I am more disappointed by her signature than any other, since, as a campaigner for Green issues, she must surely have come into contact with bad science before. You don't need me to tell you that there are thousands of people out there who provide misinformation to muddy the waters, others who claim that it's too late too act, and millions more who believe it, and are willing to argue that point. Ms Lucas must have seen through that, to the important facts of man-made climate change, and so I fail to see why it is that she can support the homeopathic cause.

Of course, there is always the argument of choice; that we should always offer people all the options, and allow them to make up their own minds. "Choice" seems like the friendly thing to do -- after all, who would want to go into a restaurant with one item on the menu? But choice is only a good thing if there are benefits on both sides ("I might like the pasta, but I also might like the rice"). If I were to offer you many options as viable alternatives to each other, but with positives only coming from one, it makes the situation needlessly complicated, and potentially dangerous ("I might like the pasta, but I also might like whatever ricin is").

You might think that that last image is a little excessive for the choice between conventional medicine and homeopathy, but the placebo effect (and I'm sure I don't need to point out that homeopathy offers NOTHING beyond the placebo effect) can only go so far. If an NHS doctor legitimises it by prescribing it, and this later makes one person consider homeopathy above conventional medicine for a life-threatening but treatable disease, then this is a life lost needlessly (and, I might add, painfully). The homeopathic industry makes enough money to publicise their sugar-pills themselves. They do not need the support of the NHS.

Andy Lewis put it well on Twitter when he described taking homeopathic medicine as "an act after being misled". In order to work as a placebo, it has to be presented as effective. In other words, doctors need to lie to patients about the effect the drugs have in order for them to have any effect at all, which would surely erode confidence in their profession. And of course, returning to the earlier issue, this actually presents patients with a false choice, as they would not be able to make their choice based on all of the relevant evidence.

Caroline Lucas tweeted her response here, saying:

EDM is about lack of BMA's consultation & argues that local NHS better placed to know patient needs, based on objective clinical assessment

But how can any "objective clinical assessment" support the use of placebo? Quite clearly, you should prescribe something that has an effect beyond placebo. Homeopathy is also as much a placebo at local level as at national, as is witchcraft (not on the NHS, but what the BMA likened to homeopathy, kicking off this row), so in taking action against homeopathy, the BMA were acting entirely within their remit.