Our foe: the fixed idea

I would like to comment on Dr Oppel’s article, “Reality check needed for CME credits” (BCMJ 2007;49[3]:109-110), which cites my conference lectures on homeopathy as inappropriate CME accreditation on two occasions. According to Microsoft’s Bill Gates, “a decline in science skills will cause North America to lose its innovative and economic edge.” Is homeopathy really that threatening?

Those of us who work in general medical practice are acutely aware that we have few tools to treat many common illnesses such as viral infections, osteoarthritis, chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, menopausal dysfunction, and chronic pain syndromes (to name just a few), and frequently side effects and cost limit many of the therapies that we do have. When patients or fellow physicians begin to look “outside the box” we can either try to rein them in or check to see what they are looking at. We might be pleasantly surprised and, if we can suspend the reflex cry “it’s not scientific” until we actually examine the research ourselves, we might add a new evidence-based tool to our armamentarium. Our patients desperately need our critical open-mindedness. And what a relief it is for us as physicians to be able to refer or offer something effective to those difficult-to-treat patients.

Homeopathy has five meta-analyses substantiating its effectiveness.[1-5] In 2006, a British study looked at outcome scores of 6544 consecutive outpatients over 23 473 visits (6 years) in which homeopathy was used in an NHS Teaching Trust hospital.[6] All of these patients had been referred by their general practitioners or hospital consultants. Positive health changes were reported in 70.7% of patients and 25% reported improvement as “much better.” Many of these patients had chronic conditions for several years and most had been seen by at least one specialist. 

In 2001, an international multicentred, prospective observational study (30 practitioners, 500 consecutive patients) compared the effectiveness of homeopathy with conventional medicine (upper respiratory complaints including allergies, lower respiratory complaints, and/or ear complaints).[7] The homeopathic response rate after 14 days’ treatment (cured or major improvement) was 82.6% compared to 67.3% for conventional treatment. The adverse events for those treated with conventional medicine were 22.3% versus 7.8% for homeopathy.

In 2006, a Health Technology Assessment report compiled on behalf of the Swiss Federal Office for Public Health supported the effectiveness, cost-effectiveness, and safety of homeopathy.[8] The evidence goes on and on.

Our biggest foe in medicine is the fixed idea. The history of medicine abounds with examples of this rigidity, unchanging in the face of new evidence, and each generation of physicians ridicules the last. The Canadian medical system is now on the brink of failure due to escalating drug costs, expensive technology, physician burnout, and a focus on treating established pathology. With many of our therapies we are stabilizing patients in poor states of health, not curing them, and have thus created the revolving door of today’s typical medical practice. We cannot afford to be rigid, expounding the fixed ideas of 20 years ago. We must look outside the box.
Although Bill Gates may occasionally be quotable, Albert Einstein often says it best: “The significant problems we have cannot be solved by the same thinking with which we created them.”

—Stephen Malthouse, MD
   General Practice, Denman Island

References

1. Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homoeopathy. BMJ 1991;302:316-323.
2. Boissel JP, Cucherat M, Haugh M, et al. Critical literature review on the effectiveness of homoeopathy. In: Homoeopathic Medicine Research Group. Overview of Data from Homoeopathic Medicine Trials. Brussels: European Commission; 1996: 195-210.
3. Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350:834-843.
4. Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: A state-of-the-art review. J Altern Complement Med 1998;4: 371-388.
5. Cucherat M, Haugh MC, Gooch M, et al. Evidence of clinical efficacy of homeopathy: A meta-analysis of clinical trials. Eur J Clin Pharmacol 2000; 56:27-33.
6. Spence D, Thompson E, Barron S. Homeopathic treatment of chronic disease: A 6-year, university-hospital outpatient observational study. J Altern Complement Med 2005;11:793-798.
7. Riley D, Fischer M, Singh B, et al. Homeopathy and conventional medicine: An outcomes study comparing effectiveness in a primary care setting. J Altern Complement Med 2001;7:149-159.
8. Bornhoft G, Wolf U, Ammon K, et al. Effectiveness, safety and cost-effectiveness of homeopathy in general practice—Summarized health technology assessment. Forsch Komplementarmarmed 2006;13(suppl 2):19-29.