I thought that the pie showed that only 13-15% of conventional techniques were purely evidence based and another 44% were of probable benefit but did not have the evidence basis demanded of homeopathic doctors for their art. I thought I was being generous in ‘giving’ orthodox medicine the whole 44 + 15 = 59% as ‘more or less evidence based’ even though my colleagues told me that such generosity had no chance of being reciprocated. But further discussions on this forum (please read the important views of this learned forum on the site of the man I like to call King of Scientism and Magician Extraordinaire, James Randi) have now convinced me otherwise.
Finally I see that this pie is profoundly misleading because as one of the above mentioned Disciples of Scientism has correctly pointed out, it somehow does not consider the frequency of use of recognised orthodox interventions.

THUS WITH DEEP REGRET I MUST CONCLUDE: The publication of such a dangerously misleading pie (and no parallel diagram to take into consideration frequency of use of interventions) is an act of profound medical irresponsibility inexplicably uncharacteristic of a publication by (until now) one of the world’s top five medical journals. British medicine simply isn’t what it used to be and from now on I will look exclusively trans-Atlantically for truth, elegance and beauty in medicine.

I really had a few good laughs while browsing at one of the internet homes of the disciples of scientism as they squirmed to defend the fact that orthodox medicine can hardly claim to be evidence based – as is clearly illustrated in the pie baked by the BMJ’s handbook of clinical evidence.

Let’s look at a one attempt at refutation and riposte to me simply drawing to attention the fact that huge swathes of orthodox medicine are simply not evidence based.

Brian Kaplan on Homeopathy and evidence based medicine

I have been wearily arguing with a couple of homeopaths on another forum for a couple of weeks now but today one has posted this link to a blog by Brian Kaplan
http://drkaplanarticles.blogspot.com/
in which Kaplan moans about the medical establishment attacking “homeopathy for not being evidence-based, the obvious implication is that orthodox, conventional medicine is indeed based on reliable evidence.”

He has found this from the BMJ
http://www.clinicalevidence.com/cewe…/knowledge.jsp
a pie chart showing the current knowledge about treatments that work.

He obviously thinks this trumps all arguments (as will the homeopaths I am talking to) because “only 15% of orthodox interventions are definitely evidence based.”

I think he is being ridiculous because 44% of treatments are beneficail, likely to be beneficial or a trade of between benefits and harms (which sounds pretty good to me), whereas homeopathy has little proof of benefit at all. Plus, at least medicine is looking at its faults and addressing them.

But I would be really interested to know what people cleverer than me make of this – and grateful for any points to further my side of the argument. Thoughts anyone?



Here are some thoughts for you, your colleagues and your allies:
Okay, out of generosity of spirit I’ll give you that 44% (even though the BMJ would definitely not) So – for the sake of discussion – now you have 59% that is more or less ‘evidence-based’. So let’s discuss the remaining 41%, shall we? That is almost 50% – or half of ‘orthodox’ practice. So what you are admitting is that almost half of what is considered as scientific medicine is actually equivalent to garbage. Rather than attack homeopathy first (and there are legitimate areas of weakness but we have never made any claim that homeopathy is such a broad spectrum panacea as the worshippers at the orthodox medical temple insist we have), why don’t you focus on the at least 41% of ‘scientific medicine’ that clearly does no good at all – but is not even politely accused of ‘not being based on evidence’?

Once that is cleared up, feel free to throw stones at the houses of homeopathic doctors and other people against whom you clearly are impressively biased.

Since I am a qualified medical doctor and an idealistic one to boot, please understand that nothing of what I say of this arises from envy or a campaign to ‘push’ homeopathy, but rather a desire for conventional medicine to come clean and admit that until the almost 50% detritus is unclogged from the orthodox system, you have no right to assail any alternatives (such as homeopathy) that are known at least to cause no harm. (Primum non nocere – Remember that one?) The latter assumption is from my perspective, since I am fully prepared to use any orthodox intervention that I see fit and appropriate in any clinical situation. In other words while you irrationally attack what I do, I will feel free to pick and choose only the best of scientific medicine for my patients and ignore big chunks of it that are not evidence based and may well cause harm to patients. Homeopaths who ignore the hard core 15% should not be defended but I don’t know any homeopathic doctors who do this.

It might be a good idea now to calculate the cost in pounds as well as morbidity/mortality of the (at least) 41% of non-evidence based conventional medicine. I predict it will be deeply shocking. Would you like to do it, or would you like it done for you by an impartial economist who will undoubtedly make your numbers look like child’s play. Why? Because they will include all sorts of measurements such as quality of life impairment, productivity losses, impact on the national budget and taxes, etc.

That 41% (at least) out there is a festering wound that you seem intent on defending or hiding with bandages. As far as I am concerned it is an 800-pound gorilla sitting in your surgeries and scientific laboratories. So why not declare a bust on ~50% of your temple now and avoid more pain down the road – it really will be to the benefit of the public at large.

Okay I’ve agreed that 15% (sometimes it’s given as 13% but I’ll give you 15%) of orthodox medicine is hard-core evidence based and homeopaths should never ignore this – and the ones I know certainly do not. Thus, any homeopath who attacks the entire edifice of medicine is almost as guilty as you so called ‘100% orthodox practitioners’ who ‘apparently’ exclusively use evidence based medicine. ‘Almost’, since the ~40-50% of unproven medicine you use poses dangers that would likely not otherwise be broached in a more benign, more whole patient oriented medical practice.

For the time being I’ll choose to watch your activities through the glass walls of your houses but really hope to see you cleaning up some of the rubbish (at least 41% of the contents, remember?). And if you have a hard time getting rid of some of the grime, I’m always available to help you steam-clean, hoover and de-louse your house in general. This is not a time for us to be uncharitable to our neighbours. In the end it is the health of the people that matters and as doctors we should all still put our patients first.

Note: May I be absolutely clear that all my comments are directed only at those critics of homeopathy who have used ‘lack of scientific evidence’ as a reason to attack, abuse and insult a system of therapeutics that whole person orientated medical doctors have used alongside orthodox medicine to serve the British public well for nearly 200 years.

The Background: Prof. Edzard Ernst and others have repeatedly attacked homeopathy on the basis that there is no evidence to suggest that it works. Ernst even went as far as to claim that homeopaths were lying to their patients – a claim to which I took the strongest possible objection: I challenged him to a duel albeit with merely words as weapons.

In the ongoing debate there is something that never seems to be sufficiently discussed. When Ernst and company viciously attack homeopathy for not being evidence-based, the obvious implication is that orthodox, conventional medicine is indeed based on reliable evidence. There is just one little problem with this implication: It is simply not true. And here is the pie that proves this. Now please know that this is not a pie baked in my kitchen. The source of this pie is the British Medical Journal of Clinical Evidence, as respectable source of information on scientific medicine as can be found on the planet. Okay, eat, swallow, digest and assimilate this pie and then we will discuss. This pie represents the proven effectiveness of modern medical interventions or treatments.

Now let’s take a deep breath, put aside all prejudices, sit back and look at the pie again and agree on 3 facts:

1. A mere 13% of medical interventions are proven to be beneficial – ie. evidence based. I suspect that’s a lot less than you thought and hardly powerful ammunition for people like Ernst and his henchmen to use against homeopathy and alternative medicine. 13% that’s thirteen per cent.

2. 21% of interventions are ‘likely to be beneficial’. That means they are likely to help but there is no hard evidence to prove this. Hmmm, that reminds me of the many thousands of patients who say they have been helped by visits to homeopathic hospitals in England.

3. We simply don’t know if 47% of interventions are of any use at all! And we are talking about drugs and surgery here – not eating an apple a day or doing 20 minutes meditation twice a day or taking a few pills that homeopathy’s detractors describe as pure placebo.
And side effects obviously occur more frequently with orthodox drugs than they do with homeopathic medicines – a fact Ernst and co. cannot deny since they think homeopathic remedies simply cannot have any effect independent of a placebo response!

So what does this say about all the attacks on homeopathy for not being evidence based and on homeopaths for lying to their patients. Now I’m going to make some strong statements here because I believe that homeopathy’s detractors have got away with murder and this really does need to be redressed:

Ernst accused homeopaths of lying ( interview in The New Scientist on the 28th April 2008) to their patients because of lack of evidence that homeopathy works. Yet only 13% of orthodox interventions are definitely evidence based. Did he accuse orthodox doctors of lying to their patients about 87% of their treatments? Did he allow the public to assume that just about all of orthodox medicine is evidence based? Did he use evidence based medicine as a club to bash homeopathy exclusively when only 13 (sic) % of orthodox interventions are definitely evidence based. Is this unequivocally honest? Is this what we expect from a Professor of Complementary Medicine? Does this reek of bias against homeopathy? Is this in the public interest?

1. If most of medicine is not evidence based and many drugs (by their manufacturers’ admission) are capable of causing side effects, this actually means that most of orthodox medicine not only lacks evidence of its efficacy but actually can do harm. And certainly more harm than homeopathy! I find this quite stunning because it means that doctors like Ernst should be telling their patients: ‘Orthodox medicine is superior to homeopathy because homeopathy is not evidence based and at least 13 (thirteen!)% of conventional medicine is! And before you make your choice let me warn you that side effects are much more common with orthodox drugs!’ Do they do this? Do politicians ever admit mistakes? Does anybody actually say ‘Fair cop guv’?

2. Homeopathic doctors do use orthodox medicines on occasion, usually when there is an excellent indication for their use in a specific clinical condition ie. strong evidence. Could this mean that homeopathic doctors tend mainly to use the orthodox interventions that comprise the 13% of the pie that represents evidence based medicine?
So is it just possible that homeopathic doctors use only the best 13% of orthodox medicine and homeopathy for everything else? You know something – this could really be close to the truth. I don’t know of a homeopathic doctor who wouldn’t treat syphilis with penicillin or appendicitis with surgery. We do use orthodox medicine when it really does work. And we do consider orthodox medicines which may be of benefit – when homeopathy doesn’t do the trick. What we don’t do is use medicines that could do a lot of harm when there is no evidence for their use. This we leave to the huge majority of orthodox doctors some of whom (such as Ernst, Baum and co.) have the audacity to criticise us!

I suggest therefore that homeopathic doctors that are respectful of the best of orthodox medicine might just be the most efficient users of evidence based medicine. This may be true simply because orthodox doctors feel obliged to use sectors of the pie (ie 87% of it) that are not evidence based simply because they feel that they must try something. Homeopathic doctors however can use their homeopathic remedies safely instead of using drugs and surgery in situations where their efficacy has not been proved and even carries the risk of doing harm. So exactly who do the general public need protection from?

Needless to say, the attacks on homeopathy will continue. I suggest to all defenders of homeopathy that citing the pie above is the best possible defence of our art. Show it to our detractors, let them taste it and if they still refuse to eat humble pie – well then be courteous and only throw it into their faces very, very gently.

Source of the pie: BMJ Clinical Evidence Handbook, Summer 2007, Figure 1, page 4 http://www.clinicalevidence.com/ceweb/about/knowledge.jsp

Supporters of homeopathy claim otherwise. We say that scientific trials of homeopathy generally show a positive effect. We say that the fact that many thousands of patients with difficult to treat conditions claiming to have been helped at NHS homeopathic hospitals for the past 200 years is also ‘evidence’ of efficacy as is the fact that homeopathy has survived this long while many other forms of therapy have come and gone.

Ernst, Baum and a group of physicians then managed to persuade PCTs (patient care trusts) to prevent GPs in many areas from sending patients for homeopathy on the NHS, a tactic that for this author implies that they think both patients and GPs are too ignorant or stupid to realise they are being duped and need to be protected from themselves. The nanny state agreed in many (but by no means all) areas and many GPs who wanted to send patients from getting homeopathic treatment on the NHS were prevented from doing so by people (in the PCTs) who are not doctors!

I’ve written about this many times and when Ernst accused homeopaths of lying to their patients I challenged him to a duel on this blog. Well a duel of words, but unsurprisingly I never heard from him. I simply read of him calling for ‘tighter controls’ on alternative medicine. Obviously he continues in his quest to protect the gullible British public (and GPs!) from their own ignorance. But in a society that seems to welcome and bleatingly acquiesce to more and more regulations, Ernst has perhaps found his time and place in the world while more libertarian people like myself blog on in the hope that people will wake up and say they are not stupid and don’t need nannies like Ernst protecting them from their own ignorance.

My next blog will be a final word on this. There is a limit to how much time I am prepared to read, think and talk about those who wish to control and coerce people whom they think are unable to think for themselves. In that blog, which will appear within a week, I will expose the incredible hypocrisy of the attacks on homeopathy using a simple pie diagram. After that, this voice will address other important medical issues of the day. However the challenge of a duel still stand, Prof. Ernst…

Tonight there will be a debate on the ‘Best of Medicine’ at the <a href=”http://www.wellcomecollection.org/exhibitionsandevents/events/WTX048079.htm
“>Welcome Collection. Homeopathy, initially nominated for the ‘Worst of Medicine’ debate scheduled for 17th July has been nominated for tonight’s debate and Dr Sara Eames of the Royal London Homeopathic Hospital will speak in favour. Should be interesting…

I won’t be there tonight but have booked my place for the 17th of July, assuming homeopathy is still nominated.

My personal opinions of the Best and Worst of Medicine:

Worst Medicine: When doctors out of fear, think of themselves first instead of their patients. Stringent regulation, box ticking and increasing fear of litigation make this more likely. Far from benefiting patients it makes them feel like they are being regarded as robots by doctors following rigid criteria about how diseases (as opposed to patients) should be treated.

Best Medicine: Well-educated doctors, instead of acting out of fear, making decisions based on knowledge, experience, wisdom and importantly, personal conscience.

The following subjects have been nominated as candidates for the Worst of Medicine.

1. The BMI farce
nominated by Patrick Basham & John Luik
The Body Mass Index is an inaccurate measurement of people’s healthiness, yet it is used to scare and hector the population.

2. Epidemiology: medicine gone wrong?
nominated by Rob Lyons
In today’s frantic search for the origins of disease in our lifestyles and environment, the value of epidemiology has been greatly overstated.

3. The homeopathy hoax
nominated by Baum and Ernst
All serious thinkers should have a closed mind on the question of homeopathy: it is anti-scientific and simply does not work.

4. Healthy living is a sickness
nominated by Dr Michael Fitzpatrick (GP & a speaker at the live debate with William Schabas, Director, Irish Centre for Human Rights & David Wootton, Professor of History, author of ‘Bad Medicine’)
GP and author Dr Michael Fitzpatrick says the injunction to be super-fit and super-healthy is ruining our quality of life.

Let’s look a little closer at these:
1. BMI: Of course this is not a totally accurate measurement of ‘health’. Who says it is? It does give useful information as does an ‘apple-shaped’ body. There is no way this can ‘win’ the title of Worst Medicine and it seems that it’s just being nominated to give someone a chance to voice an opinion on its limited usefulness in medicine.
2. Epidemiology: The worst of medicine? That’s ridiculous too. It may have its limitations, it may indeed have been overstated but it’s always been a valid science and useful it its place. Another ridiculous nomination.
3.Healthy Living is a sickness – Yeah, sure and life is a terminal, sexually transmitted disease. A really insightful observation.
4.Which leaves Homeopathy is a Hoax – clearly set up not only to lose but to be trashed in public.

I think I’ve made the point several times that homeopathy is not a hoax which would imply that homeopaths know that they are deceiving their patients. I challenged Edzard Ernst to a duel for accusing homeopaths of lying to their patients. I chose words as weapons but to date have received no answer – which does not surprise me. A challenge to a duel was considered an honorable response to the slur of an accusation of lying in this country 150 years ago so I’ve done my job in defending the honour of homeopathy. Ernst and others may believe that what homeopaths tell their patients is untrue but that does not mean they are lying. Richard (The God Delusion) Dawkins and Christopher (God is not Great) Hitchens are obviously no great fans of the Almighty and clearly do not agree with what the Pope or any other religious leaders say but as far as I know, they are not accusing these leaders of lying.

Ernst has accused homeopaths of lying. Ernst and Baum are accusing homeopaths of perpetrating a hoax (in this discussion)
I’ve had enough insults from these eminent professors. I don’t know if they will attend the debate on the 17th of July but I’ll be there. So dear reader, why not come along to a free debate in central London and give your view.

Anyway let’s wrap up a few points.

1. The Duel: I challenged Prof. Ernst to a duel (with only words as weapons) for accusing homeopathic doctors of lying to their patients. Guess what? No reply. The age of chivalry, ladies and gentlemen is dead – but at least I tried.

2. Attack on Homeopathy is pernicious: I must justify that and I will. The club used to try to beat homeopathy into submission is that it is not evidence based. Now to look at all health interventions on this basis would be fair and consistent. If something has the requisite quality of evidenced you put a tick next to it if it does not you put a cross but it’s only fair to look at all medical interventions this way.

Ernst, Singh, Goldacre, Baum et al have conveniently allowed the public to believe that conventional medical interventions are all evidence based and homeopathy is rubbish because it is not. Both statements are patently untrue. Interpretation of trials of homeopathy is controversial to say the least and but I won’t get into that here other than to say it is not at all ‘well established’ that the trials show that homeopathy is no better than placebo. In fact most trials in my opinion seem to show that it does have a clinical effect independent of placebo.

My first accusation is more serious – that the public are being misled by omission. These eminent doctors are conveniently not telling the public something very, very important and that is this (please forgive the capitals but if I could make light shine out of the screen though the letters in the next sentence I would) MANY, MANY INTERVENTIONS IN ORTHODOX MEDICINE ARE NOT EVIDENCE-BASED. And although these are used in serious conditions such as coronary heart disease, depression (to the tune of hundreds of millions of NHS pounds) and back pain – there is no attack on them by those that attack homeopathy and CAM. I’ve listed these before but let me say once again to Ernst et al who selectively attack homeopathy and CAM for not being evidence based.

Surgery: Show me the evidence base for spinal fusion for chronic back pain.
Paediatrics: Show me the evidence base for the use of drugs such as Prozac and Ritalin in ADHD
Cardiology: Show me the evidence for angioplasty and stents in coronary heart disease.
Psychiatry: Show me the evidence for the use of SSRI anti-depressants for depression.

and there are many, many more but I don’t want to bore you with long lists.

And if you can’t… Let me say this:

You accuse homeopaths of only getting results by the placebo effect with no evidence. And if you are right (and I certainly DO NOT think you are) you should applaud rather than attack homeopaths for getting results with what you think is merely placebo. Why do I say this?

Because surely it’s better and safer to get results with what you think are just pills of sugar of milk than to get results with unproven interventions which use chemicals and even scalpels on patients?

Double standards? You bet!

In my last article I challenged Professor Edzard Ernst to a duel (okay – with only words as weapons) for accusing homeopaths of lying to their patients. For centuries in this country the slur of being accused of lying was considered one of the main reasons for challenging someone to a duel. It was actually considered the gallant thing to do in the circumstances – otherwise the accusation of lying would leave a stain on your character. Of course I have not been accused personally of lying – but as a doctor who does use homeopathy – I certainly object to being generically accused of lying. This was an insulting, wrong and vicious thing to say. The slur can be ameliorated if Ernst admits that it is simply a matter of his English not being up to scratch on that occasion and that what he meant to say was that homeopaths were saying things to their patients that he, Ernst, considered to be untrue. Lying is a different matter and as I’ve said I have never met a homeopathic doctor whom I thought was lying to his patients and I’ve met hundreds of them.

I regret to inform you that no answer to my challenge of a duel has been received. Perhaps Ernst prefers to confer with journalists than doctors. He has received far too much publicity already in my opinion. I don’t know what his qualifications or motives are other than the smearing of homeopathy and complementary medicine in this country. The paradox of this is that he claims to have been a homeopath and is apparently still a professor of complementary medicine! I don’t want to give the ghastly negative book he wrote with Simon Singh any more publicity than it has received – but feel the need to reiterate what I consider the hypocrisy and duplicity that is at its core.

The basic claim is that most of CAM and especially homeopathy are not ‘evidence based’ (This morning on Radio 4’s Today programme, I heard someone say that we live in an ‘evidentially-based’ society. Holy Jupiter! Must we have our language as well as our society totally deconstructed and then destroyed?) My answer to this was simple: Ernst knows that much of conventional medicine (eg spinal fusion, use of drugs for ADHD in children, angioplasty and stents and many many more examples) is not evidence based. How can he then selectively use ‘evidence based medicine’ as a club to bash homeopathy? Surely he should use it as a weapon to attack any form of medical intervention that lacks the requisite trials and results? Nobody addresses this point and people like Simon Singh and Edzard Ernst outrageously get away with an approach that reeks of double standards. In fact Dr Damien Downing has written an excellent piece on Ernst and his approach in the journal of the Alliance for Natural Health which articulately points out how much of what Ernst says applies far more to himself than to those he attacks.

So in bullet form:

1. Much of CAM is not evidence based. (fact)
2. Much of conventional medicine is not evidence based. (fact)
3. Therefore it is two-faced and hypocritical to use evidence based medicine as a weapon to attack CAM and homeopathy.

It could be used to attack any medical intervention that is not evidence based. That would be consistent but I would still be against attacking interventions that are not evidence based. We should allow doctors to practise the art of medicine as well as the science. This means they are allowed to use interventions that have worked for them or their colleagues and mentors and that suit their style of medicine and personality. Of course in critical situations if they ignore the evidence-based recommended approach to the detriment of their patients they will be called to account.

It’s all quite simple really. What is amazing is the amount of publicity this duplicitous, hypocritical and negative campaign has achieved with the result that quangos such as PCTs (Patient Care Trusts comprising mainly non-medical people) are able to threaten NHS homeopathic hospitals with closure by preventing doctors in their areas from choosing to refer patients to homeopathic hospitals! Yes you heard me correctly. Unelected committees consisting mainly of non-medically qualified people have exercised their power under the present system of financing healthcare on the NHS, to prevent GP’s from choosing to send selected patients to other doctors (homeopathic consultants) at homeopathic hospitals! And this has occurred because people like Ernst, Baum and others have misled the media and public by giving them the impression that orthodox medicine is all evidence based (it certainly is not) and that homeopathy and CAM are not (studies of multiple trials do not clearly demonstrate that homeopathy is no better than placebo – as Dr Downing clearly points out in his excellent article).

I plead ignorance of their true motives but the fact that so far they have been allowed to get away with this heist and get huge exposure on all the media for their propaganda with the result that many GPs have been prevented from referring patients to specialist homeopathic doctors is not merely tragic for decency and honesty in medicine; it is no less than an embarrassment for liberal democracy in this country.

WHO AM I?
I am a medical doctor who uses a whole person orientated approach which comprises everything conventional medicine has to offer and some methodologies which it does not offer. These include Homeopathy but also Autogenic Therapy (now there is something both Prof. Ernst and I agree is an excellent adjunct to orthodox medicine) and Provocative Therapy which is the clinical application of reverse psychology in medicine and psychotherapy. Patients consult me because they know I will try to choose from these, the sort of medicine that is most appropriate for their particular situation. This could be a combination of any of the above or it might involve referral to a conventional specialist or to a member of a group of holistic physicians that I meet with on a weekly basis.

MY MENTOR: I was fortunate to have a mentor, E.K. Ledermann, a medical philosopher, psychiatrist and physician who also used homeopathy in his 70 years of holistic practice in London. He impressed on me both the importance of the mechanistic approach of orthodox scientific medicine when appropriate and the need for a holistic general practitioner to have knowledge of psychotherapy as well as some whole person orientated medical tools at his or her disposal. I see homeopathy (alongside other methods such as traditional Chinese medicine) as a powerful example of such a tool.

HOMEOPATHY: Thus homeopathy is an holistic tool that a doctor can use – but only when it is appropriate to do so. In no way does it ‘replace’ conventional medicine. In no way should it ever be used in situations where there is a risk of morbidity or mortality. In many other situations it can be used (in our opinion) to stimulate the inherent regenerative power of the body. If it fails to do the job, we homeopathic physicians are ethically obliged to use conventional medicine to do whatever it can for the patient.

It is my belief that doctors using homeopathy in their practices have served the people of Britain well (including every monarch since the early 19th century) and I am proud to be a fellow of the Faculty of Homeopathy.

Having declared who I am let me now restate what I think of the recent attacks on homeopathy on the basis that it is not scientific and particularly that it is not evidence-based medicine.

HOMEOPATHY, CONVENTIONAL MEDICINE AND ‘EVIDENCE’: Recently homeopathy has coming under stinging attacks for not being ‘evidence based’. By far the most significant of these attacks was an open letter to Patient Care Trusts by a group of British professors including Michael Baum and Edzard Ernst among others. The idea appeared to be to persuade these trusts not to allow GPs in their areas to refer patients to NHS homeopathic hospitals because homeopathy was not evidence based. Ernst went on to write a book with a journalist Simon Singh continuing these attacks and in interview also allegedly accused homeopaths of lying to their patients – an accusation that I felt morally obliged to respond to and did. Other journalists such as Ben Goldacre then joined the lynch mob and everyone continued to use evidence based medicine as the club with which to bash homeopathy.

Along the way a few lone voices occasionally cried out: ‘Hey, not all orthodox medicine is evidence based is it?’ But all the attacks on homeopathy by Ernst, Baum, Singh, Goldacre and others are based on homeopathy apparently not being evidence based which implies that orthodox medicine is evidence based. Otherwise these learned men of medicine and journalism should simply attack ALL medicine that is not evidence based, unless of course there is another agenda here.

Well I started to look at the evidence base treatments in common usage in orthodox medicine. And what did I find? A HUGE number of treatments in frequent usage and generating huge revenue for doctors and pharamaceutical companies simply cannot claim to be evidence based. A good place to prove this is the British Medical Journal of Clinical Evidence. A short time spent there will show you what I say to be true. How dare these people attack homeopathy for lacking an evidence base and by their attitude allow the public to assume that orthodox medicine is all evidence based? It’s an absolute disgrace and I’d like anyone who disagrees to tell me why.

Just for starters here is a short personal list I have of orthodox treatments that are not evidence based. If anyone thinks they are please send me the evidence and I’ll remove that item from the list. And this list is just a sample for starters. It will certainly be continued.

1. The use of drugs such as antidepressants and others for Attention Deficit Hyperactivity Disorder in children.

2. The surgical procedure of spinal fusion for many forms of back pain.

3. The use of SSRIs for depression – a treatment that costs the NHS hundreds of millions of pounds a year and yet a recent study by a highly respectable group of researchers concluded that these drugs are no better than placebo!

4. Antibiotics to prevent endocarditis
In this weeks ‘placebo’ issue of the BMJ there was a letter by Neil Herring and David Sprigings that expressed worry over the fact that guidelines on antibiotic prophylaxis in structural heart disease for preventing infective endocarditis have now been changed by NICE because they have found no evidence base forits effectiveness. There have been no(sic) RCTs on this subject.

5. Steroids for prevention of ARDS In the Research section there is also a paper ‘Corticosteroids in the prevention and treatment of ARDS in adults; a meta-analysis’ by Peter, John, Graham, Moran,George and Bersten that showed no convincing treatment effect of steroids in the condition. However the authors also state that ‘meta analysis based on a small number of trials with sparse data must be cognisant of limitations in estimation of treatment effects’. You don’t see people saying that about trials of homeopathic medicines do you? I wonder why not.

FINALLY:
I must state that I don’t believe that doctors should be coerced into EXCLUSIVELY using approaches which are evidence-based. I didn’t go to medical school to become a robot. Successful medical practice is an art in which the practitioner uses the tools that suit his or her particular talents and personality. Of course in life threatening situations or where there is risk of morbidity, the standard proven protocols MUST be used. Doctors must be free to practice the art of medicine according to their own consciences. Of course if patients come to grief because of this the doctors can and will be held to account. But selectively to attack and insult a group of doctors (in this case those that use homeopathy in their practices both privately and on the NHS) on the basis that homeopathy is not evidence based while knowing full well that much of conventional medicine similarly lacks the type of evidence base they self righteously scream for in homoepathy, is in my opinion both duplicitous and pernicious.