Evidence-based medicine, "placebos" and the homeopathy controversy

Homeopathic treatment has been available on the UK’s National Health Service (NHS) since 1948. In recent years the continued provision of homeopathy through the NHS has been increasingly questioned as part of the ascendency of evidence-based medicine (EBM). Indeed, in 2009 the House of Common’s Science and Technology committee commenced an ‘Evidence Check’ inquiry into Government policy supporting the NHS provision of homeopathic treatments. The controversy over whether homeopathic treatments ‘really’ work and whether they should be available through the NHS has generated much debate: at the heart of the controversy are questions about the nature of evidence in medicine, the validity of randomised trials and the nature and utility of ‘placebo effects’. Critics of homeopathy put forward the simple argument that best available evidence shows homeopathic treatments to be equivalent to placebo, and therefore conclude that it should not be available through publically funded healthcare. This thesis presents a critical examination of the concepts of EBM and ‘placebos’ and re-evaluates their role in the controversy around homeopathy. This thesis examines what kind of foundation the EBM philosophy of evidence provides for the arguments made in the controversy, and the role that ‘placebos’ play as both an evidential and normative standard. There are two basic arguments: first, that the arguments justifying the EBM philosophy of evidence are fundamentally unclear, but also that the interpretation given to EBM, in debates about homeopathy, cannot be sustained. Second, that the concept of ‘placebos’ should be abandoned entirely: a framework is developed for talking about the effectiveness of treatments that removes much confusion about the epistemological and ethical standards that effective treatments should be held to. In addition to attempting to provide conceptual clarity to the controversy, the main conclusion is that the Science and Technology Committee have (on the basis of their own assumptions) understated their evidential arguments, by ignoring mechanistic evidence for whether homeopathic treatments are effective, and they have overstated their ethical arguments, they do not provide good reasons to remove provision of homeopathic treatment through the NHS.EThOS - Electronic Theses Online ServiceGBUnited Kingdo