Lib Dems in a tangle over homeopathy


6:51 pm - March 13th 2010

by Unity    


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A couple of weeks ago James Graham helpfully documented one of the more rapid reverse ferrets in recent political history; the rapid withdrawal of a wholly idiotic Lib Dem statement made in response to the Science and Technology Committee’s recently published evidence check report on homeopathy. This week, James is back with a revised Lib Dem statement on homeopathy which he bizarrely describes as ‘sensible and measured’. Frankly, ‘disingenuous and weaselling’ would be a rather more apt description of the new statement, which reads as follows:

A recent report by the House of Commons Science and Technology Committee examined the provision of homeopathy through the NHS and called for funding by the NHS to be stopped. The Committee did recognise that many users derive benefit from its use and did not argue that such treatments should be banned.

When it comes to NHS provision, we support a review by NICE into the cost effectiveness of Complementary and Alternative (CAMs) therapies, including homeopathy; as well as expanding the work of NICE to look at the cost-effectiveness of existing conventional treatments.

The Liberal Democrats believe that, as a basic principle, individuals should have maximum freedom about how they choose to get treated, so long as the therapy is safe. We know that many complementary therapies are popular with the public. The NHS budget is limited and we want to make sure that NHS funding is focused on treatments which are efficacious and cost-effective. NICE reviews of all existing treatments would give us the best possible basis for future decisions over funding.

An important correction needs to be made right from the outset because what the committee actually concluded in regards to patient benefit was:

16. We do not doubt that homeopathy makes some patients feel better. However, patient satisfaction can occur through a placebo effect alone and therefore does not prove the efficacy of homeopathic interventions.

Homeopathy has no medicinal value beyond that of the placebo effect, and that because the sugar pills and magic water dispensed by homeopaths are nothing more than placebos that contain no active medicinal ingredients. Once you understand that simple fact then you quickly come to appreciate that everything that follows in the Lib Dem’s position statement is a complete and utter nonsense.

Asking NICE to review the cost effectiveness of homeopathy is about as sensible a use of time and public money as asking the Ordinance Survey to conduct a review of the evidence base collated by the Flat Earth Society.

Calls for more research and for expensive and time-consuming NICE reviews are nothing more than a delaying tactic; a last desperate attempt to stave off the inevitable by a branch of pseudoscience that has had two hundred years to come with credible evidence for its efficacy and failed miserably at every turn. There is no particular shortage of research evidence relating to homeopathy. The problem that its supporters face is the fact that the only trials that purport to show that homeopathy has any effect beyond that of a placebo are uniformly poor in quality and wholly unreliable as evidence where properly conducted systematic reviews and meta-analyses of existing research have failed to find any evidence to support the view that homeopathy is at all efficacious.

Knowing that to be the case, why should we continue to throw good money after bad?

We don’t use public money to fund researchers to look for evidence of the existence of phlogiston or luminiferous aether nor do we send archaeologists on expeditions in search of Shangri-La, Lemuria or Atlantis, so why should we continue to piss public money down the drain on homeopathy?

We shouldn’t – it’s as simple as that.

As for making an appeal to personal liberty and patient choice, don’t make me laugh!

If you genuinely want NHS patients to have a real choice, an informed choice, then you have to start out by telling them them truth and explaining to them that what they’re going to get, if they visit a homeopath, is a bunch of bullshit and voodoo with a sugar pill at the end of it and nothing more. Of course, the problem with telling patients the truth is that placebos don’t work anything like as well if the patient knows that what they’re getting a placebo.

Patient choice is a self-negating concept when it comes to homeopathy, one that raises a number of significant ethical questions for the NHS in regards to the legitimacy of using placebos to treat patients.

The only credible policy that the Lib Dems, or indeed any other party, can adopt on this issue is that of accepting the recommendations made by the Science and Technology Committee in full and without equivocation:

33. By providing homeopathy on the NHS and allowing MHRA licensing of products which subsequently appear on pharmacy shelves, the Government runs the risk of endorsing homeopathy as an efficacious system of medicine. To maintain patient trust, choice and safety, the Government should not endorse the use of placebo treatments, including homeopathy. Homeopathy should not be funded on the NHS and the MHRA should stop licensing homeopathic products.

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'Unity' is a regular contributor to Liberal Conspiracy. He also blogs at Ministry of Truth.
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Reader comments


Its not just the Lib Dem’s who are confused on the issue, many of the serial rebels from the Labour Benches have also spoken out in support of Homeopathy. Proof you can’t have it all.

See A Very Public Sociologist on Homeopathy’s surprising allies and here for Jeremy Corbyn’s response on why he supports Homeopathy:

@leftoutside I believe that homeo-meds works for some ppl and that it compliments ‘convential’ meds. they both come from organic matter…

Deeply distressing stuff from lots of people I respect when it comes to Homeopathy.

Well homeopathy is certainly not the most important problem when deciding how to vote, but it is tragic to see the Lib Dems rooting their policy firmly in the early 19th Century.

See my blog post
“A handy list of dimwitted members of parliament” http://www.dcscience.net/?p=2829

The irony is that Lib Dems have two of the people who understand science best in Phil Willis and Evan Harris. But they seem to have decided to ignore them and go for an out-of-touch weasel words that show a total misunderstanding of evidence,

3. Steve atkinson

There are enough real medical issues with effectivel treatments or badly needed research that needs funding. It’s criminal to fund this nonsence. Politicians get a grip.

Ugh. Is it really too much to ask that one of our oh-so wise political leaders speaks out against homoepathy? I mean is it really that much of a vote-loser that no-one can be bothered to state the flamin obvious ie: it is a waste of NHS money? All power to the House of Commons Science and Technology Committee I say.
Shame the Libdems can’t align themselves with rational thought just yet.

That statement (assuming it’s official) seems to read more like a rejection of treatments that are not both “efficacious and cost-effective”. I’d certainly hope that NICE would fail homeopathy on the first of these grounds.

I think you are making a basic error in assuming that the placebo effect is either irrelevant, or constant and uniform.

Dedicated and specialist placeboists could quite conceivably turn out to be better at the job that generalist practitioners. Perhaps on average, and if not perhaps for some identifiable subset of patients (sometimes, swallowing bullshit is a survival trait). It may or may not be the case that those patients are cured in some abstract philosophical sense, but in the practical measurable terms of not bothering the doctor and going off and living their lives, they either are or aren’t.

Those measurable variations in the placebo effect are precisely the things that an efficiency study would capture, and a standard placebo-controlled medical trial wouldn’t.

Perhaps by coincidence, the Lib Dems are right on this, whereas you seem a bit confused about the difference in goals between medicine (cure people) and science (discover truth).

If someone voluntarily and informed consent to be lied to (which quite obviously anyone who goes along see to a homeopathist is practically demanding), and that lie turns out to work, I don’t see any big ethical issues.

Soru: any decision that placebos should be prescribed is a major ethical point of contention. Arguments on both side, but it’d need serious debate in itself. At present homeopathy is being used in a deceptive manner.

8. rob tennant

haha, didn’t the Lib Dems have great fun laughing at the Green Party over their own idiotic policy on homeopathy last year, just before the Euros? if i recall a Lib Dem member called Martin Robbins laid into the Greens the day before the Euro elections. whilst it doesnt really matter, as they can only have lost a few votes – various nerds and other online freaks who think homeopathy is a big issue compared to the economy and climate change – it was quite damaging. as a result the Greens have now changed their policy.

and now look what we have here: Lib Dems going in for a bit of woo!

9. Earnest Ernest

homeopathy…well done.

C’mon. At least recognise the huge potential contribution of homeopathy to cutting the budget deficit:

– lower cost of NHS prescriptions for medication

– patients’ longevity reduced so less payout of state pensions

“C’mon. At least recognise the huge potential contribution of homeopathy to cutting the budget deficit:

– lower cost of NHS prescriptions for medication

– patients’ longevity reduced so less payout of state pensions”

Bob – tongue in cheek I assume! But on a serious note, the reason homeopathy seems to ‘work’ is the pastoral aspect i.e. people just get more time with the professional they see (as highlighted by the SciTech Committee); they feel cared for and for many patients that alone can increase their feeling of wellbeing. But this time must come at a huge cost; nor does it mean that physiological problems willbe solved and that they will live a longer and healthier life.

I would rather the NHS was using precious resources to maximise patient time with actual medical doctors so we can have the advantages of this placebo effect combined with proper diagnosis and medication; as someone who votes LibDem I am deeply concerned that the party is not taking a tougher stance and drawing a red line on this issue.

Even making use of NICE’s resources to assess this seems daft; does that mean some seriously ill patients will have to wait for bona fide medication to be OK’ed?

What happens if homeopathy does have some benefit- it must surely terrify the drug companies!

@12

well yes. in the same way that if it was found that the earth was flat it would terrify physicists.

11
You make a valid point, it has long been known that the ‘placebo effect’ is misunderstood, in many cases, it isn’t only the effect upon the physiology, by drugs, which brings about wellness,but the actual social process surrounding the administration. The ‘bedside manner’ is really an art not a science.
This makes it doubly difficult when testing psychotropic medication (mood-changing) when subjects involved in the trials are asked to self-report, the placebo effect is also present for subjects who have actually taken the drug.
There is also a moral debate within the mental health services about treating people from ethnic backgrounds who are presenting with extreme anxiety because of culturally determined beliefs eg. possession. Should we merely mask the affect with anxiolytics, or employ the services of a witchdoctor to perform an exorcism?
I’m sure there’ll be a lot of raised eyebrows by this suggestion, but it is a fact that people suffering from mental illness in third world countries have a better outcome than those within the west. Not necessarily because of witchdoctors but the identified difference in social acceptance.

My error, I was responding to 6

16. Matt Munro

@ 6 Good points. Worth noting that until the 1970s it was quite legal and widespread for doctors to prescribe placebos to what we would now call the “worried well”.

The point about homeopathy is not that it’s “no more effective than placebo” it IS placebo. The feeling of well being is driven both by “the medicine” and (arguably more important) the directed attention of a caring professional (the adminstrator of “the medicine”). Both are powerfull social constructs that create a high expectation of healing . It’s thwerefore possible that it might actually generate a net saving to the NHS money if it keeps whining, middle class neurotics out of GPs surgeries.

The thing a lot of people don’t seem to graps is that “feeling better” (a subjective psychological experience) is not the same as responding to an effective treatment (clinically measurable improvement in symptoms) and that many of the conditions in which users claim benefit from homeopathy tend to be those which have a high psychological component (e.g minor skin conditions, “allergies” and back pain).

It doesn’t stop at homeopathy, – whats needed is a wider debate about the supposed benefits of all sorts of “health” advive much of which is actively promoted by the government, for the which the evidence base is shakey at best.

What really interests me about para 33 of the report, quoted by Unity, is what it implies about other common treatments as well as homeopathy. UK doctors write 31million prescriptions for anti-depressants each year, even though anti-depressants have been shown to be no more effective than a placebo except in the most severe cases of depression, and even then the difference is slight.

Two points arise from this. Firstly anti-depressants are, I suspect, a much greater drain on NHS financial resources than homeopathic treatments. Secondly, as the slightly puzzling “mass homeopathy overdose” demonstration showed recently, you can’t harm yourself with homeopathic remedies. However, anti-depressants may not help you, but they can certainly harm you, and an overdose can cause permanent damage or kill you.

So, logically, if prescription of placebo remedies is to be proscribed, then the ban should start with anti-depressants.

18. rob tennant

Normally whenever LibCon points out the stupidities of Lib Dem policy or strategy, you get a flood of Lib Dems on here accusing all and sundry of being Labour partisans.

No, we just don’t like holier-than-thou fools with a penchant for silly right-leaning nonsense.

Where are Mat Bowles (MatGB) and Alix Mortimer? Normally you can’t mention the Lib Dems without getting attacked as being Labourites byt those two. Maybe it’s because they’re all down at their little conference. I hope Clegg’s Spectator interview and praise of Thatcher went down well!

Soru:

I know perfectly well that the placebo effect is anything but irrelevant but, as others have rightly pointed out, the use of placebos raising a number of complex ethical questions that need to addressed properly.

That’s a debate that the medical profession should undertake but its something of a separate issue to the use of homeopathy which is, after all, nothing more than an archaic exercise in sympathetic magic.

Jane:

What you’ve picked up on there is an issue that bedevilled the use of anti-depressants more or less since day one.

While there are some people whose depression does genuinely stem from a biochemical imbalance in the brain, for which drug therapies can be an effective treatment, for many more their issues are purely psychological and would be better addressed using talking therapies.

It is no real surprise, therefore, to find that in many cases the only benefit that anti-depressants confer is that of acting as a placebo.

That said, before we get too far into the business of labelling them as a major drain on NHS resources we need to consider what the costs of providing talking therapies on the same scale might be.

It’s not as straightforward an issue as it might first appear.

Rob:

Mat and Alix may well be busy with the conference but I suspect that neither will be particularly enamoured of this particular statement, which is very much the point of this article.

If you’ll recall, the Greens responded very positively to the criticism they got from Martin and have since reviewed their policies and implemented a number of significant improvements.

Having raised this issue, I’d hope that the Lib Dem members/activists who read LC would respond in the same manner and apply a bit of pressure on their own party in support of the SciTech committee’s findings and the excellent work undertaken by two of their own MPs, Phil Willis and Evan Harris.

Martin Robbins is, BTW, very much one of the good guys here and highly respected by other skeptics and science bloggers, myself included.

22. rob tennant

Unity,

Indeed. Why hasn’t Martin criticised the Lib Dems for this? The timing of his article last year was clearly designed to damage the Green Party just before a set of Euro elections they were tipped to do very well in (of course their reasons for not doing so go far beyond what some bloggers on the internet said about them). The woo policies had been there for quite some time, and could’ve been criticised well before the election to give the Greens some time to change, which they have done now. I’d say the timing of this post is a bit unfortunate, given the Lib Dems are getting a lot of mostly good media coverage, but hey ho.

Unity,

Yes the first letter was wrong which is why it was withdrawn. But, when you consider how a democratic party makes policy, the actual position as set out in the new position statement is sensible and measured – as James Graham has now described it.

This is because our party has a policy (voted for openly by the representatives at a party conference) on all CAM therapies that are available on the NHS – that is that they should all be reviewed by NICE to see if any cross the cost-effectiveness threshold. Given that homeopathy is not efficacious I am confident that a NICE review will not demonstrate cost-effectiveness.

We called for this years ago.But the current Labour Government has refused to allow NICE to do this whereas under the Lib Dems this would have been done long before the select committee enquiry. Perhaps LC , Unity and David Colquhoun should now concentrate their fire on those parties with either no pollcy or one which seeks to maintain NHS funding of homeopthy without even an examination.

It seems that even in the blogosphere the most sensible position (NICE review of NHS funding) of all the parties gets attacked by both sides!

Evan Harris

I think the interesting thing is that it is in no-ones POLITICAL interest, rather than scientific, to essentially tell a lot of people that believe in homoeopathy that they’re crazy and it’s stupid of them to want it all funded on the NHS.

I was quite interested by Evan Harris’ response above, as it makes some political sense. If you’re going to tell people that you can’t have it on the NHS, certainly in the current economic climate, then the argument of it not being the most cost-effective manner to get treated has to be the politically correct one to put across.

Evan:

On the question of other parties, Martin and others at the Skeptics Wiki already have that in hand and after Mike O’Brien’s abysmal performance at the SciTech committee, I’ve no doubt at all that the government will be getting very short shrift here when they publish their response.

As regards a general NICE review of CAM, it has to be remembered that a fair number of the so-called therapies that operate under that label can be readily dismissed without the need to waste time and money on a formal review. Before reviewing anything, some consideration needs to be given to the question of scientific plausibility, if NICE is not to become bogged down in arguments over idiotic notions like ‘theraputic touch’ and ‘distance healing’.

At least the Lib Dems don’t have David Tredinnick calling for government funding of medical astrology. Mote and beam!

Following from Unity @25.

How about acknowledging the work of Professor Edzard Ernst at the Peninsula Medical School? He’s already done a lot of what Evan suggests. The Lib Dems could simply acknowledge his work and pledge continued support for his department, currently facing closure due to a funding crisis allegedly due to a spat with Prince Charles.

28. Roger Mexico

Surely the important point is that, with the way it’s done on the NHS in Britain, homeopathy is almost the perfect way to manage and maximise the placebo effect.

Patients are referred to conventionally trained doctors who can and should spot anything serious and get it treated properly (and can be jumped on by the GMC if not). Water is about as harmless as you can get. Side effects, though possible – the power of the mind works both ways – tend to be a lot less; unlike say antidepressants. And as discussed above it’s got to be cheaper than throwing pharmaceuticals down people’s throats.

Like it or not doctors have to deal with a lot of situations where there’s not much they can do: self-limiting conditions, the worried well, vague aches and pains investigated to death, conditions best left alone despite patient demands. If they can say “Go and see Dr Woo the Homeopath – he’s had some success with problems like these”, at worst they’re getting a medical second opinion. At best the placebo effect works its magic charm and the patient feels better.

It may disturb some people’s sense of medical ethics, but given that the most basic ethical rule is “do no harm”, I can’t see how the current use of homeopathy on the NHS fails that.

I take it seriously if I get ticked off, be it ever so gently, by Evan Harris. I’ve pressed for evaluation by NICE for many years. It was recommended in the House of Lords (2000) report, and it was recommended by the Prince of Wales himself, or at least it was the primary (but forgotten) in his Smallwood report.

I and many of my friends have written to the Dept of Health, to ask them to ask NICE to do it. Michael Rawlins (head of NICE) says he is willing to do it if asked, but isn’t allowed to do it on his own initiative. Hence Labour comes out of this controversy far worse than Lib Dems. Conservatives of the Tredinnick stripe simply live on another planet.

The Dept of Health, under Labour, has taken an equally unenlightened view of the best way to regulate things like Traditional Chinese Medicine. They are considering the recommendation of the ghastly Pittilo recommendations at the moment. See, for example, http://www.dcscience.net/?p=2329 It wouldn’t be surprising if they take their customary box-ticking approach, despite that vast body of scientific and medical opinion that it would be silly to give Traditional Chinese Medicine the same status as doctors.

I’d certainly argue that it would be a waste of time and energy for NICE to review the seriously barmy forms of alt med, like homeopathy and distant healing. But I can see the strength of the political argument that it would provide external verification for a policy to remove them from the NHS

@28

You can get a placebo effect simply through reassurance from a doctor. Homeopathy is simply a waste of money. When there isn’t enough money for more needed, proven treatments then funding homeopathy is unethical.

The opposite of the placebo effect is less well known. Called the nocebo effect, it can be just as powerful. How much it is consciously or unknowingly played on by CAM practitioners is an interesting question. If they tell you that conventional medicine is poisoning you and you start feeling ill when you take your meds, is it due to the power of their suggestion causing a nocebo effect?

Its too easy to view CAM practitioners as a bunch of harmless middle-class hippies. In fact it is a multi-million pound industry that has managed to avoid proper regulation. It has ethical skeletons in its closet and isn’t the benign nemesis of Big Pharma it tries to portray itself as.

31. Roger Mexico

Yurrzem!

That wasn’t quite my point. Of course any form of intervention will cause some kind of placebo effect, it’s just the way that homeopathy is used on the NHS tends to maximise it and to reduce the associated risks (like many things in Britain this is entirely accidental of course).

I agree with you about the danger of the nocebo effect (which is why I aluded to it) but again an NHS homeopath is unlikely to condemn meds like a private and unqualified CAM practitioner would. Taking homeopathy off the NHS would probably only encourage the “evil chemical” vs “good natural” dichotemy that infest the press and magazines and any generalised nocebo effect that that has.

I suspect an awful lot more money is wasted on “go away” drugs from GP’s than what you could rack up on fancy water pills. No doubt the cost of those is inflated after the Laura Ashley wing of Big Pharma have put their mega profit margins on – but that’s an arguement for NHS generics.

If homeopathy goes off the NHS, it won’t vanish. It’ll just be left in the hands of the CAM types who at best are ignorant and at worst dangerous.

On the non- evilbigpharmanastychemical front, I think it’s worth putting in a request to properly fund evidence-based dentistry, psychology, physiotherapy, chiropody, dietetics, counselling, smoking cessation support, screening, education, and so on. We needn’t resort to quacks.

33. Matt Munro

Psychology – Depends which bit of spychology and what you use it for most of it is now a branch of sociology due to hijaking by the anti-science left/feminists, dumbed down, over simplified and cherry picked.

Counselling – Not as effective as widely beleived, and certainly not a cure all. Only really works on certain groups (middle-class women) whose “problems” are trivial

Smoking cessation therapty – utter bollocks, funded by the “nicotine replacement” industry with the collusion of govt

Screening – usually not the best use of limited resource – money would be better spend on traetment/research

Big pharma – Is it a coincidence that the rise of big pharma coincided with increasing life expectancy ? Not to be trusted, but then nor are hippy snake oil salesmen…………

That’s a debate that the medical profession should undertake but its something of a separate issue to the use of homeopathy which is, after all, nothing more than an archaic exercise in sympathetic magic.

Why is it separate?

Modern medicine can use radiation, heroin, maggots and any number of other generally harmful substances to beneficial effect. Given that, I don’t see what the problem is with using bullshit in a controlled and safe environment.

Left Outside is right. The recent EDM proves that sadly this is an issue which appears to unite the dimmer bulbs of all parties.

Unity, I fear you’re a little confused. Firstly, the Science and Technology Committee recommend that NICE evaluate homeopathy (paras 87-90). Indeed, they are quite expansive:

“We consider the issue of NICE evaluation important because it ensures patient safety and evidence-based practice. Additionally there is variation in practice across the country with some PCTs funding homeopathy and others not.”

You say this is not necessary, and yet call for all parties to accept the recommendations “in full and without equivocation”. Which is it?

I have to admit to not being ecstatic about Norman Lamb’s second slice of fudge; I think he skips around the subject of placebo entirely. Indeed I think he may actually be responsible for partially proving the homoepathic effect in that the less he opens his mouth, the more effective Lib Dem health policy becomes. But with that caveat aside, I would be very wary of any government implementing a select committee report and bypassing the independent expertise that is available. Select committees are, by definition political creatures. NICE at least aspires to be above all that and, broadly, does its job well (despite what a number of Tories have to say about it). An NICE inquiry need not be expensive and consist of much more than a literature review, but it would be necessary in my view. And I am delighted that the Science and Technology agree with me, in full, and without equivocation.

@43:

I don’t see what the problem is with using bullshit in a controlled and safe environment.

The problem is that you can’t tell the patient that it’s bullshit, or it doesn’t work. Lying to the patient about the efficacy of a treatment drives a truck through the concept of “informed consent”. Any treatment which requires a doctor to actively lie to the patient is ethically dubious at best.


Reactions: Twitter, blogs
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  12. Dr. Nancy Malik

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  17. Elrik Merlin

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  18. fatrat

    LibDems talk rubbish about Homeopathy http://liberalconspiracy.org/2010/03/13/lib-dems-in-a-tangle-over-homeopathy/

  19. Alan Henness

    RT @david_colquhoun: Utterly pathetic RT @lecanardnoir: #LibDem "disingenuous and weaselling" statement on homeopathy. http://bit.ly/b3DTW4 Please comment

  20. Chris Coltrane

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  21. uberVU - social comments

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  26. David Colquhoun

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  27. Margot Tudor

    Despite the efforts of the very fine MP Evan Harris, the Lib Dems seem to be horribly pro-homeopathy http://bit.ly/b3DTW4

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  30. Liam Proven

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  31. John Coxon

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  32. links for 2010-03-15 « Embololalia

    […] Liberal Conspiracy » Lib Dems in a tangle over homeopathy If you genuinely want NHS patients to have a real choice, an informed choice, then you have to start out by telling them them truth and explaining to them that what they’re going to get, if they visit a homeopath, is a bunch of bullshit and voodoo with a sugar pill at the end of it and nothing more. Of course, the problem with telling patients the truth is that placebos don’t work anything like as well if the patient knows that what they’re getting a placebo. […]





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