Do you think it is acceptable to routinely lie to patients about what medication they are getting, and whether it is working?
I would disagree with some others who have answered this question, and I believe that it is not acceptable to deceive patients with placebo medications, regardless of your motives.
I think it is useful to refer to the four basic ethical principles here[1], which are:
- Principle of respect for autonomy
- Principle of nonmaleficence,
- Principle of beneficence, and.
- Principle of justice.
Respect for a patient's autonomy dictates that a patient has the right to be involved in decisions regarding their healthcare, and that their wishes should be respected. A key part of ensuring patient autonomy is to obtain their informed consent on the matter. Informed consent does not, of course, simply mean blindly accepting the decisions of the medical team, rather means understanding the benefits and risks, and agreeing to proceed. (Of course, consent can be withheld for any reason whatsoever (or indeed, no reason whatsoever) in consenting adults).
In order to give patients this information, we need to give them evidence. It is therefore not ethically acceptable to simply give patients placebos or homeopathic remedies on the premise that they work and have an evidence base. They do not, at least not beyond the placebo effect. The British Homeopathic Association does claim that homeopathy has an evidence base [2], however they do not address the many meta-analyses of homeopathic trials that are freely available online, demonstrating little to no overall benefit in homeopathic remedies. Some such studies point out that in higher quality trials, the benefits of homeopathy become less significant. [3] Others point out that the quality of trial data is so poor that generating decisive conclusions is simply not possible. [4]
With the principle of autonomy in mind, one should not simply prescribe homeopathic medication without explaining the rationale behind the treatment and the evidence base - which for homeopathy could be most simply described as "there is no evidence that this works, but some people feel that it helps their condition".
Non-Maleficence is the principle of not doing harm. It is hard to argue that homeopathic medications in themselves do any harm, considering that even the British Homeopathic Association is quite open that the tablets consist of natural substances in extremely dilute forms (in many cases, so dilute that the compound is no longer likely to even be present in the resulting medication) added to lactose tablets. [5] It is hard to argue that simple sugar pills can cause any harm. I would argue, however, that homeopathy in general does tend to cause patients to distrust traditional medicine, and I would be very disturbed if patients were not seeking genuine medical attention and receiving proven, evidence based treatments based on their belief that medicine "failed" them and homeopathy "saved" them. (Although I hasten to add that many homeopathic practitioners do work alongside conventional medicine, and do in fact recognise that importance of scientifically proven therapies).
Beneficence is the principle of doing good. Whilst I have no doubt in my mind that most if not all homeopathic practitioners do genuinely believe that they are helping their patients, the evidence that the homeopathic remedies provide any benefit to their patients is poor. Homeopaths generally specialise in treating chronic conditions, and relapsing-remitting conditions, which by their very nature often change without medical intervention. Examples given on the British Homeopathic Association's website include mostly (but not exclusively) examples of chronic, relapsing-remitting conditions where traditional medicine has made relatively little progress; including chronic headaches, dysmenorrhoea, chronic back pain, psoriasis, chronic sinusitis, seasonal allergic rhinitis and vertigo. [6]
Justice is the principle of fairness. I do not think it just that homeopathic remedies receive public funding whilst patients continue to wait for genuine, evidence based treatments. The NHS has only got limited funds, and I would strongly argue that these need to be used wisely to provide access to scientifically sound, evidence based treatments that provide positive outcomes for patients.
I would hope it goes without saying that all patients, including those who choose to take homeopathic remedies, should be treated with equal respect by their healthcare practitioners.
Looking through the arguments for homeopathy, I cannot support the existence of homeopathy as part of the NHS, nor can I argue that prescribing homeopathic remedies (or indeed any other placebo) can be morally justified. Whilst I would agree that some people do benefit from the placebo effect, and that the physical side effects from the medications are at worst minimal, I would suggest that prescribing homeopathic medications as potentially scientifically proven therapies cannot be ethically justified. It impedes on the patient's right to autonomy by removing the possibility for them to make a truly informed decision about their healthcare. Even if homeopathic remedies were explained to the patient as being a placebo, I do not think it just to waste valuable NHS resources on an unproven treatment when access to scientifically sound treatment on the NHS is, frankly, not as easy as it should be (although this is a whole other story that I won't go any further into).
If consenting adults wish to waste their own money on homeopathic remedies, then that is their decision. I nevertheless believe that they should be aware of the lack of evidence base in homeopathy before doing so, and believe that the many fallacious claims made by the homeopathic industry regarding evidence should be vociferously and publicly challenged by the scientific community.
References
[1]
R Gillon, "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540719/pdf/bmj00449-0050.pdf", BMJ 1994 309: pp184-8
[2]
British Homeopathic Association: The Evidence Base, accessed 28/2/15
[3]
A Shang et al, "Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy", Lancet 2005 366: pp726-32
[4]
RT Mathie et al, "Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis", Systematic Reviews 2014, 3:142
[5]
The Medicines; British Association of Homeopathy, accessed 28/2/15
[6]
The Evidence for Homeopathy, British Association of Homeopathy, accessed 28/2/15
