Homeopathy is Equal to Nocebo

Homeopathy is Equal to Nocebo

Homeopathy is considered to be identical to placebo, being the Oakland of pseudo-medicine. There is no there there. But for the sake of the blog we will pretend the a homeopathic medicine and placebo are different. Zero and 0 are not the same thing.

All the meta-analyses have found that for efficacy, homeopathy is no different from placebo No surprise there.

But how about for complications and side effects? A nocebo is

…an inert substance or treatment that appears to cause an adverse effect on a patient or participant although it has no known biological effect.

I mostly assume that my interactions with patients are going to be beneficial even though I know intellectually it is not so and that most of the adverse reactions, no matter how peculiar, are going to be caused by the antibiotic I am giving

As a clinician I tend to not consider the nocebo effect.  Sometimes when I am describing potential complication of therapies to patients I have to be careful in how I phrase a side effect as I get the sense that some patients will report whatever complication I mention.   People can be suggestible.

What is the degree to which the nocebo effect can be induced in patients?

The meta-analysis demonstrated that the proportion of patients experiencing adverse effects to be similar for patients randomized to homeopathic treatment compared to patients randomized to placebo and conventional medicine.

Which is a fascinating result that homeopathy can harness the power of nocebo so effectively. The meta-analysis is a reminder that patient interactions are not always beneficial even when nothing is prescribed.  Offering a therapy that does nothing can result in harm by inducing nocebo.  

I also smile that another adverse effect,  the so called homeopathic aggravation, which is where a symptom intensifies after the homeopathic nostrum, also known in the real world as progression of disease when the therapy has no effect.  

When my patients worsen I have to actually consider that my choice of therapy may be ineffective. It must be nice: if the patient gets better, the treatment is working and if the patient worsens the treatment is working. No room for failure.  

Homeopathy is not as intrinsically harmless as might be expected.  It harms by allowing disease progression and by inducing the nocebo effect.  


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