It is my experience over the last 15 years that enthusiasts of ineffective alternative treatments tend to resort to two strategies when faced with convincingly negative data. The first is to slight the bearer of bad news, and the second is to call for a paradigm shift. Dr Swayne seems to do both. He affronts me by stating that I suffer from ‘tunnel vision’ and am ‘obsessive’. And he goes to some length explaining that, in order to do it justice, homeopathy needs a new paradigm. Call me naïve, but I had thought that a new paradigm is needed when the experimental data no longer fit the existing ones. In the case of homeopathy, this is evidently not the case. The results of the Spence study1 are very easily explicable within the existing paradigm. The bulk of the randomised controlled trials evidence tells us that homeopathic remedies are placebos.2 The improvement observed by Spence et al is therefore probably due to a range of factors unrelated to the treatment itself: natural history of the disease, regression to the mean, social desirability, concomitant interventions, etcetera.
If Swayne suggests that we should take observational studies more seriously than randomised controlled trials, he is not really advocating a paradigm shift. De facto, he is suggesting to implement double standards — one for homeopathy and one for conventional medicine. Or does he propose that we apply his standard throughout medicine? In this case, we have to concede that HRT reduces cardiovascular and cancer risks (as shown by observational studies) and ignore that it does, in fact, achieve the opposite (as demonstrated in randomised controlled trials). The ‘paradigm pioneer’ is thus disclosed as what he really is: a misguided evangelist preaching a gospel that leads us straight back into the dark ages of medicine,3 to the indisputable detriment of our patients.
- © British Journal of General Practice, 2008.
