A recent study suggests that about 60% of doctors in Scotland have prescribed either homeopathic (49%) or herbal (32%) remedies in the past year. Although only 5% of doctors were responsible for 50% of such prescribing, these are still alarming numbers.

Study author, Dr. James McLay, is quoted as saying, “The major problem with homeopathic preparations is the lack of scientific evidence that they are effective.”

While I agree that this is the major problem with herbal remedies, I would rank it #2 for homeopathic remedies. There is nothing far-fetched about herbal remedies. They are, put simply, drugs. They are just not very good drugs – they have not been purified, all their active ingredients have not been identified, and they are not properly studied. They are often prescribed with insufficient supporting evidence – sometimes based upon nothing but slick marketing.

Homeopathic remedies (although often included with herbs as “natural” remedies) are a completely different kettle of fish. It is certainly true that they lack evidence of efficacy, and this is a significant problem. But Dr. McLay’s statement reflects what I believe to be the modern bias of evidence-based medicine (EBM). EBM is a formal movement within healthcare to do two things: improve the flow of scientific information to practitioners, especially at the point of decision-making; and to assess medical interventions based upon a standardized assessment of evidence.

As far as it goes, EBM is great. However, it is specifically lacking a very important concept – that of scientific plausibility. EBM advocates, in fact, think it is somehow unfair to consider such things. For most mainstream medical modalities this philosophy may be practical (even if I would still disagree with it). We don’t have to know how something works to know that it works. But at the extreme end of scientific implausibility EBM breaks down entirely.

Homeopathic remedies are diluted to such an outrageous degree that there is an insignificant probability of even a single molecule of active ingredient remaining. There is no even theoretical mechanism for the water to retain any chemical properties of what was diluted in it. And the other notions about activating the preparation with shaking, and “like cures like” are pure magic. As much as we can say anything in science, we can say that there is no possible way homeopathy can work. This is the “major problem” with homeopathy.

What the EBM’ers miss is that such extreme scientific implausibility should at least raise the bar for evidence. The evidence for homeopathy should not be treated the same as the evidence for aspirin and heart disease.

They also miss the important fact that bizarre pseudoscientific beliefs, like homeopathy, exist in a culture of bizarre pseudoscience. This breeds many true-believers, who are doing bad science, or committing “pious fraud” to convince the world and those nasty skeptics that their cult beliefs are true. This muddies the waters for EBM, and it just can’t handle it.

I am not advocating getting rid of EBM – on the whole it’s a good thing. But it must change. It must reintroduce the idea of scientific plausibility. What we need is science-based medicine.

It is misguided to exclude logic and reason from medicine out of a sense of fairness. Scientific practitioners need to rediscover and express their outrage that pure nonsense is infecting the healthcare systems of the world. Maybe then we will see homeopathy wane in Scotland and elsewhere.