I’m fine with people wasting their money on sugar pills, but I have higher expectations of government bodies. The Medicines and Healthcare Regulatory Authority has decided to let homeopathy manufacturers make medical claims on their sugar pill bottles, without any evidence of efficacy, and the government funds homeopathy on the NHS. This week the Parliamentary Science and Technology Select Committee looked into the evidence behind these decisions.
There was much cheap comedy – as you’d expect from a government inquiry into an industry based on magical beliefs. But the best moment was when Dr Peter Fisher from the Royal London Homeopathic Hospital (funded by the NHS) explained that homeopathic sugar pills have physical side effects, so they must be powerful. Many raised their eyebrows; but interestingly, the homeopath is correct. People can experience side effects when they receive pills that contain no medicine at all.
A paper published in the journal Pain next month looks at this very issue. Its authors found every single placebo-controlled trial ever conducted on a migraine drug, and looked at the side effects reported by the people in the control group, who received a dummy ‘placebo’ sugar pill instead of the real drug. Not only were these side effects common, they were also similar to the specific side effects you’d have expected if you’d received real drug in the trial: so patients getting placebo instead of anticonvulsants, for example, reported memory difficulties, sleepiness and loss of appetite, which are typical side effects of anticonvulsants; while patients getting placebo instead of painkillers got digestive problems, which themselves are commonly caused by painkillers.
This is nothing new. A study in 2006 sat seventy-five people in front of a rotating drum to make them feel nauseous, and gave them a placebo sugar pill. Twenty-five were told it was a drug that would make the nausea worse: their nausea became worse, and they also exhibited more gastric tachyarrhythmia, the abnormal stomach activity that frequently accompanies nausea.
A paper in 2004 took six hundred patients from three different specialist drug-allergy clinics, split them into two groups at random, and handed them either the drug that was causing their adverse reactions, or a dummy pill with no ingredients: 27 per cent of the patients experienced side effects such as itching, malaise and headache from the placebo dummy pill.
And a classic paper from 1987 looked at the impact of listing side effects on the consent form which all patients sign before accepting treatment in a randomised trial. This was a large placebo-controlled trial comparing aspirin against placebo, conducted in three different centres. In two of them, the consent form contained a statement outlining various gastrointestinal side effects, and in these centres there was a sixfold increase in the number of people reporting such symptoms, and many more people dropping out of the trial, compared with the one centre that did not list such side effects on the form.
This is the amazing world of the nocebo effect, the evil twin of the placebo effect, where negative expectations can induce unpleasant symptoms in the absence of a physical cause.
Sadly, though, it doesn’t help homeopaths: in 2003 Professor Edzard Ernst conducted a systematic review of every single homeopathy trial that reported side effects. This found, in total, fifty episodes of side effects in patients treated with placebo and sixty-three in patients treated with homeopathically diluted remedies, with no statistically significant difference in the rates of side effects between the two groups.
Quacks like to present themselves as holistic, but in reality this research into the placebo effect and the nocebo effect suggests quite the opposite. The world of the homeopath is reductionist, one-dimensional, and built on the power of the pill: it cannot accommodate the fascinating reality of connections between mind and body, which have been revealed in these experiments, and many more. The next time you find yourself trapped, at dinner, next to some bore who’s decided they have secret mystical healing powers – while they earnestly explain how their crass efforts at selling sugar pills represent a meaningful political stand against the crimes of big pharma – just think: some lucky person, somewhere in the world, is sat next to a nocebo researcher.