Dianthus Medical Blog Archive

My application for a job in homoeopathy

Posted on 19 Aug 2010 and filed under Medical ethics 0 Comments

Those of you who follow homoeopathy stories in the blogosphere will be aware that NHS Tayside are currently advertising for a "Specialist Doctor in Homeopathy". If you are not familiar with this story, and some of the excellent job applications it has generated, you might want to catch up with it here, here, or here (and probably many other excellent blogs as well, apologies to anyone I've missed out).

I did try applying for the job myself a few days ago, using the well known homoeopathic principle that dilution makes things stronger, but for some strange reason, my application seems to have been ignored. So I thought it might be fun to send in a more detailed application. This is what I sent.

Dear Imogen

I would like to apply for the job of a specialist doctor in homeopathy.

First, however, I would like to express my admiration for your patience and hard work in dealing with all the applications you have had for the post. I gather you have had an excellent response so far, and that some applications may not have been entirely serious. The professionalism you have shown in handling those applications does you credit.

I should state up front that I too am not a qualified homoeopath. But before you throw up your hands in horror and shout “Oh no, not another one!”, please be assured that my application is very different from the other ones you have received from detractors of homoeopathy.

I genuinely believe that, in some limited circumstances, homoeopathy can be an entirely valid form of treatment. You can check my homoeopathy-supporting credentials by reading a blog post that I wrote long before your vacancy was advertised (http://dianthus.co.uk/homoeopathy-is-it-all-bad).

So, what do I mean by “homoeopathy-supporting”? Clearly, I’m not suggesting that there is any scientific basis whatsoever to any supposed mechanism of action of homoeopathic treatments as a result of some magical ability of water to somehow absorb the mystical crystal healing vibrations of arnica or whatever it was once in contact with, while simultaneously conveniently forgetting about all the industrial waste that the same water molecules will also have once got to know. No, that would just be silly. Homoeopathy is, obviously, totally devoid of any pharmacological activity (the technical term for substances like this is “placebo”). Not only would any pharmacological activity be totally incompatible with the laws of chemistry and physics as we know them, but there is also an enormous body of evidence showing that homoeopathic treatments are equivalent to placebo treatments in a wide range of conditions.

Anyone who believes that homoeopathic treatments have some sort of magic powers that are responsible for their effects is clearly delusional. Talking of which, if you receive any applications for this job from genuine homoeopaths, you might want to check out whether they hold any delusional beliefs. I don’t know what your policy is on such things, but if I were in charge of your hospital, I would feel rather uncomfortable about allowing people with delusional beliefs near patients. Just saying.

At this point, you are probably starting to think “you don’t sound much like a supporter of homoeopathy to me”. But you would be wrong. Let me explain.

The fact is, homoeopathy is equivalent to placebo, and for a great many minor medical conditions, placebo is actually quite a good treatment. It is well documented, for example, that in mild forms of depression, almost as many patients respond to placebo as to powerful antidepressants. Obviously it would be irresponsible to prescribe placebo for any conditions for which effective treatment is available, and please be assured that if I were to be offered the job, I would be fully aware of the limits of placebo treatment, and would refer patients to proper doctors without hesitation if I had even the slightest suspicion that they might actually be ill.

However, the fact remains that a great many patients have medically unimportant, self-limiting, but nonetheless troubling symptoms, and such patients often benefit from placebo treatment. This is an important argument in favour of homoeopathy, and yet you will rarely hear detractors of homoeopathy acknowledging that argument (bizarrely, it is even more rare for supporters of homoeopathy to make that argument).

There are, of course, ethical issues in prescribing placebo treatment. It is widely believed to involve deception, which many would consider an unacceptable breach of the trust that is so important in the doctor-patient relationship. However, I regard that merely as a challenge to be overcome, rather than an absolute bar to prescribing placebo. I would explain to patients that I am prescribing a homoeopathic treatment, and that although modern science shows that it is no more than a placebo, many patients believe that it has helped them. A lot of patients don’t trust modern science anyway, so that kind of statement, as well as being entirely honest, would probably not seriously affect most patients’ belief that the treatment would be effective, particularly those who were daft enough to let themselves be referred to a homoeopath in the first place.

To be honest, I do still have some slight nagging doubts about a little ethical concept called “informed consent”, but I note that you would expect the successful applicant to undertake both CPD activities and research, and I would love to spend my CPD and research time getting to grips with how those little ethical niggles can best be ironed out. And obviously, my approach is far more ethical than the approach of a homoeopathic believer, who will actually deceive patients by pretending he or she is prescribing a substance with some activity. That cannot possibly ever be acceptable.

There are, of course, further advantages to placebo treatment. One advantage is that, as it is devoid of any pharmacological activity, it has a very low risk of side effects. It is also cheap. In fact, I have some ideas for how you could make your homoeopathic treatments even cheaper than they are already and save yourselves a considerable portion of your homoeopathic budget, but we can discuss those ideas at the interview. I wouldn’t want to give all my secrets away right now.

I realise that your advert asks for a “doctor”, and perhaps I should mention that I am not medically qualified. However, I do have a PhD, so I could quite happily introduce myself to patients by saying “Hello, I’m Dr Jacobs”. I realise that such an introduction in a medical setting could be regarded as slightly dishonest, but I’m sure you’ll agree that it is an extremely minor deception in comparison with prescribing homoeopathic treatments, and as we’ve already seen, even that deception should not be an insoluble problem if handled properly.

In understand that the next stage in the application procedure is for you to send me an application pack, which I look forward to receiving.

Yours sincerely

Adam

Dear Imogen

I would like to apply for the job of a specialist doctor in homoeopathy.

First, however, I would like to express my admiration for your patience and hard work in dealing with all the applications you have had for the post. I gather you have had an excellent response so far, and that some applications may not have been entirely serious. The professionalism you have shown in handling those applications does you credit.

I should state up front that I too am not a qualified homoeopath. But before you throw up your hands in horror and shout “Oh no, not another one!”, please be assured that my application is very different from the other ones you have received from detractors of homoeopathy.

I genuinely believe that, in some limited circumstances, homoeopathy can be an entirely valid form of treatment. You can check my homoeopathy-supporting credentials by reading a blog post that I wrote long before your vacancy was advertised (http://dianthus.co.uk/homoeopathy-is-it-all-bad).

So, what do I mean by “homoeopathy-supporting”? Clearly, I’m not suggesting that there is any scientific basis whatsoever to any supposed mechanism of action of homoeopathic treatments as a result of some magical ability of water to somehow absorb the mystical crystal healing vibrations of arnica or whatever it was once in contact with, while simultaneously conveniently forgetting about all the industrial waste that the same water molecules will also have once got to know. No, that would just be silly. Homoeopathy is, obviously, totally devoid of any pharmacological activity (the technical term for substances like this is “placebo”). Not only would any pharmacological activity be totally incompatible with the laws of chemistry and physics as we know them, but there is also an enormous body of evidence showing that homoeopathic treatments are equivalent to placebo treatments in a wide range of conditions.

Anyone who believes that homoeopathic treatments have some sort of magic powers that are responsible for their effects is clearly delusional. Talking of which, if you receive any applications for this job from genuine homoeopaths, you might want to check out whether they hold any delusional beliefs. I don’t know what your policy is on such things, but if I were in charge of your hospital, I would feel rather uncomfortable about allowing people with delusional beliefs near patients. Just saying.

At this point, you are probably starting to think “you don’t sound much like a supporter of homoeopathy to me”. But you would be wrong. Let me explain.

The fact is, homoeopathy is equivalent to placebo, and for a great many minor medical conditions, placebo is actually quite a good treatment. It is well documented, for example, that in mild forms of depression, almost as many patients respond to placebo as to powerful antidepressants. Obviously it would be irresponsible to prescribe placebo for any conditions for which effective treatment is available, and please be assured that if I were to be offered the job, I would be fully aware of the limits of placebo treatment, and would refer patients to proper doctors without hesitation if I had even the slightest suspicion that they might actually be ill.

However, the fact remains that a great many patients have medically unimportant, self-limiting, but nonetheless troubling symptoms, and such patients often benefit from placebo treatment. This is an important argument in favour of homoeopathy, and yet you will rarely hear detractors of homoeopathy acknowledging that argument (bizarrely, it is even more rare for supporters of homoeopathy to make that argument).

There are, of course, ethical issues in prescribing placebo treatment. It is widely believed to involve deception, which many would consider an unacceptable breach of the trust that is so important in the doctor-patient relationship. However, I regard that merely as a challenge to be overcome, rather than an absolute bar to prescribing placebo. I would explain to patients that I am prescribing a homoeopathic treatment, and that although modern science shows that it is no more than a placebo, many patients believe that it has helped them. A lot of patients don’t trust modern science anyway, so that kind of statement, as well as being entirely honest, would probably not seriously affect most patients’ belief that the treatment would be effective, particularly those who were daft enough to let themselves be referred to a homoeopath in the first place.

To be honest, I do still have some slight nagging doubts about a little ethical concept called “informed consent”, but I note that you would expect the successful applicant to undertake both CPD activities and research, and I would love to spend my CPD and research time getting to grips with how those little ethical niggles can best be ironed out. And obviously, my approach is far more ethical than the approach of a homoeopathic believer, who will actually deceive patients by pretending he or she is prescribing a substance with some activity. That cannot possibly ever be acceptable.

There are, of course, further advantages to placebo treatment. One advantage is that, as it is devoid of any pharmacological activity, it has a very low risk of side effects. It is also cheap. In fact, I have some ideas for how you could make your homoeopathic treatments even cheaper than they are already and save yourselves a considerable portion of your homoeopathic budget, but we can discuss those ideas at the interview. I wouldn’t want to give all my secrets away right now.

I realise that your advert asks for a “doctor”, and perhaps I should mention that I am not medically qualified. However, I do have a PhD, so I could quite happily introduce myself to patients by saying “Hello, I’m Dr Jacobs”. I realise that such an introduction in a medical setting could be regarded as slightly dishonest, but I’m sure you’ll agree that it is an extremely minor deception in comparison with prescribing homoeopathic treatments, and as we’ve already seen, even that deception should not be an insoluble problem if handled properly.

In understand that the next stage in the application procedure is for you to send me an application pack, which I look forward to receiving.

Yours sincerely

Adam

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