Should doctors recommend homeopathy? Sometimes placebos work, that is why placebo has an Effect named after it and, because they are inert, they can't do any harm. But when patients or taxpayers are coughing up money for it, the issue is more murky.

Peter Fisher, Director of Research at the Royal London Hospital for Integrated Medicine, says that of all the major forms of complementary medicine, homeopathy is the most misunderstood. He says how regular medicine reviews homeopathy is. For example, in a recent report by the Australian National Health and Medical Research Council which stated that "there are no health conditions for which there is reliable evidence that homeopathy is effective." 

"The fact that one homeopathic treatment for a condition is ineffective doesn't mean that another is also ineffective," Fisher says. 

In other words, he is claiming that if you can't prove it doesn't work for all things, it is equivalent to medicine which has survived double-blind clinical trials. 

Obviously, peer review of homeopathy - by homeopaths - comes out looking as good as peer reviews of evolutionary psychology by evolutionary psychologists, so reviews of homeopathy look favorable. The Swiss government made the mistake of asking for a Health Technology Assessment and the panel finding that it was "probably" effective for upper respiratory tract infections and allergies, and that is now used as a trump card by homeopaths. Various meta-analyses of homeopathy by homeopaths have been positive, but scientists know that In an unweighted random-effects meta-analysis, anything as possible, as long as large outliers are included. 

He also points to several studies comparing treatment outcomes of conventional family doctors with those who integrate homeopathy in their practice, showing better outcomes at equivalent cost in a range of conditions with reduced use of antibiotics.

He concludes that "Doctors should put aside bias based on the alleged implausibility of homeopathy. When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including antimicrobials. Health professionals trained in homeopathy do not oppose the use of conventional treatments, including immunisation."

Edzard Ernst, Emeritus Professor at the University of Exeter, says most independent systematic reviews of randomized controlled trials "have failed to show that homeopathy is effective" and reviews with positive conclusions "usually have serious methodological flaws."

The assumptions underlying homeopathy "fly in the face of science" he says "and critics have long pointed out that unless our understanding of the laws of nature is incorrect, homeopathy's mode of action has no rational explanation."

He also argues that homeopathy can harm "if it replaces an effective therapy" and says he knows of "several deaths that have occurred in this unnecessary way."

Finally, he questions Europe's €1bn annual spend on such remedies, saying these funds "could and should be spent more usefully elsewhere."

In summary, he says, "the axioms of homeopathy are implausible, it's benefits do not outweigh its risks, and its costs and opportunity costs are considerable. Therefore, it seems unreasonable, even unethical, for healthcare professionals to recommend its use."

Citation: BMJ 2015;351:h3735