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Wilhelm M, Euteneuer F. Does Health Literacy Make a Difference? Comparing the Effect of Conventional Medicine Versus Homeopathic Prescribing on Treatment Credibility and Expectancy. Front Psychol 2021; 12:581255. [PMID: 34140910 PMCID: PMC8204743 DOI: 10.3389/fpsyg.2021.581255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective While homeopathic remedies are often used to treat non-specific complaints such as headaches, empirical evidence suggests their treatment effect is due to the placebo effect. Low health literacy seems to be connected to higher use of complementary and alternative medicine (CAM). The aim of this study was to examine what people with occasional headaches expect from conventional medicine or homeopathic remedies and if health literacy interacts with this expectation. Methods In this experimental study, n = 582 participants with occasional headaches were randomized to read one of two vignettes, which described the prescription of either conventional medicine or a homeopathic remedy. Subsequently, the participants were asked to rate treatment credibility and expectancy with regard to their assigned vignette. Health literacy was assessed as a potential moderator. Results Participants in the conventional medicine group rated treatment credibility and expectancy higher than in the homeopathic remedy group. Moderation analysis revealed that when being offered conventional medicine, participant reports of treatment credibility and expectancy decreased with lower health literacy, while these outcomes increased with lower health literacy for homeopathic remedies. Discussion People with occasional headaches estimate the effectiveness of conventional medication properly. However, health care professionals should pay special attention to patients with low health literacy, as they might need more time and information to give their informed consent.
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Affiliation(s)
- Marcel Wilhelm
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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Tutty E, Hickerton C, Terrill B, McClaren B, Tytherleigh R, Stackpoole E, Savard J, Newson A, Middleton A, Nisselle A, Cusack M, Adamski M, Gaff C, Metcalfe S. The expectations and realities of nutrigenomic testing in australia: A qualitative study. Health Expect 2021; 24:670-686. [PMID: 33635607 PMCID: PMC8077070 DOI: 10.1111/hex.13216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Consumer genomic testing for nutrition and wellness, (nutritional genomics), is becoming increasingly popular. Concurrently, health-care practitioners (HPs) working in private practice (including doctors interested in integrative medicine, private genetic counsellors, pharmacists, dieticians, naturopaths and nutritionists) are involved as test facilitators or interpreters. OBJECTIVE To explore Australian consumers' and HPs' experiences with nutrigenomic testing. METHOD Semi-structured in-depth interviews were conducted using predominantly purposive sampling. The two data sets were analysed individually, then combined, using a constant comparative, thematic approach. RESULTS Overall, 45 interviews were conducted with consumers (n = 18) and HPs (n = 27). Many of the consumer interviewees experienced chronic ill-health. Nutrigenomic testing was perceived as empowering and a source of hope for answers. While most made changes to their diet/supplements post-test, self-reported health improvements were small. A positive relationship with their HP appeared to minimize disappointment. HPs' adoption and views of nutrigenomic testing varied. Those enthusiastic about testing saw the possibilities it could offer. However, many felt nutrigenomic testing was not the only 'tool' to utilize when offering health care. DISCUSSION This research highlights the important role HPs play in consumers' experiences of nutrigenomics. The varied practice suggests relevant HPs require upskilling in this area to at least support their patients/clients, even if nutrigenomic testing is not part of their practice. PATIENT OR PUBLIC CONTRIBUTION Advisory group included patient/public group representatives who informed study design; focus group participants gave feedback on the survey from which consumer interviewees were sourced. This informed the HP data set design. Interviewees from HP data set assisted with snowball sampling.
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Affiliation(s)
- Erin Tutty
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
| | - Chriselle Hickerton
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
| | - Bronwyn Terrill
- Australian Genomics Health AllianceVictoriaAustralia
- Kinghorn Centre for Clinical GenomicsGarvan Institute of Medical ResearchSydneyNSWAustralia
- St. Vincent’s Clinical SchoolUNSWSydneyNSWAustralia
| | - Belinda McClaren
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
| | - Rigan Tytherleigh
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
| | - Elaine Stackpoole
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Present address:
Genetic Services of Western AustraliaSubiacoWAAustralia
| | - Jaqueline Savard
- Kinghorn Centre for Clinical GenomicsGarvan Institute of Medical ResearchSydneyNSWAustralia
- Sydney Health Ethicsthe University of SydneySydneyNSWAustralia
- Present address:
School of MedicineFaculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Ainsley Newson
- Kinghorn Centre for Clinical GenomicsGarvan Institute of Medical ResearchSydneyNSWAustralia
- Sydney Health Ethicsthe University of SydneySydneyNSWAustralia
| | - Anna Middleton
- Society and Ethics ResearchConnecting ScienceWellcome Genome CampusCambridgeUK
- Faculty of EducationUniversity of CambridgeCambridgeUK
| | - Amy Nisselle
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
| | - Marie Cusack
- Australian Genomics Health AllianceVictoriaAustralia
- Centre for Genetics EducationNSW HealthSydneyNSWAustralia
| | - Melissa Adamski
- Department of Nutrition, Dietetics and FoodMonash UniversityMelbourneVictoriaAustralia
| | - Clara Gaff
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
- The Walter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
| | - Sylvia Metcalfe
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
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Ijaz N. Paradigm-Specific Risk Conceptions, Patient Safety, and the Regulation of Traditional and Complementary Medicine Practitioners: The Case of Homeopathy in Ontario, Canada. FRONTIERS IN SOCIOLOGY 2020; 4:89. [PMID: 33869409 PMCID: PMC8022581 DOI: 10.3389/fsoc.2019.00089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/26/2019] [Indexed: 06/12/2023]
Abstract
While the principle of risk reduction increasingly underpins health professional regulatory models across the globe, concepts of risk are neither static nor epistemically neutral. Conventional biomedicine's risk conceptions are substantially rooted in principles of scientific materialism, while many traditional and complementary medicine systems have vitalistic epistemic underpinnings that give rise to distinctive safety considerations. The statutory regulation of traditional and complementary medicine providers has been identified by the World Health Organization as a strategy for enhancing public safety. However, complex risk-related questions arise at the intersection of medical epistemologies whose concepts are at best overlapping, and at worst incommensurable. Elaborating a theoretical concept of "paradigm-specific risk conceptions," this work employs Bacchi's poststructural mode of policy analysis ("What's the Problem Represented to Be?") to critically analyze risk discourse in government documents pertaining to the 2015 statutory regulation of homeopathic practitioners in Ontario, Canada. The Ontario government's pre-regulatory risk assessments of the homeopathic occupation discursively emphasized cultural safety principles alongside homeopathy-specific risk conceptions. These paradigm-specific concepts, rooted in homeopathy's epistemic vitalism, extend beyond materialist constructions of adverse events and clinical omission to address potential harms from homeopathic "proving symptoms", "aggravation," and "disruption," all considered implausible from a biomedical standpoint. Although the province's new homeopathy regulator subsequently articulated safety competencies addressing such vitalistic concepts, the tangible risk management strategies ultimately mandated for practitioners exclusively addressed risks consistent with the scientific materialist paradigm. This policy approach substantially echoes the implicit biomedical underpinnings evident in Ontario's broader legislative context, but leaves a significant policy gap regarding the primary safety considerations originally articulated as substantiation for homeopathy's statutory regulation. To optimally preserve patient safety and full informed consent, regulators of traditional and complementary medicine professionals should favor a pragmatic, epistemically-inclusive approach that actively negotiates paradigm-specific risk conceptions from both biomedicine and the occupation under governance.
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Nelson DH, Perchaluk JM, Logan AC, Katzman MA. The Bell Tolls for Homeopathy: Time for Change in the Training and Practice of North American Naturopathic Physicians. J Evid Based Integr Med 2019; 24:2515690X18823696. [PMID: 30789055 PMCID: PMC6343431 DOI: 10.1177/2515690x18823696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
North American naturopathic medicine is a distinct form of practice that is woven into the larger fabric of integrative medicine; in a number of US states and Canadian provinces, naturopathic doctors enjoy a wide scope of practice, including the ability to make diagnoses, order tests, use medical technology, write prescription drugs, and perform minor surgeries. However, the basic premise of naturopathic medicine and its guiding principles-considering the whole person and supporting healthy lifestyle behaviors-is the unifying approach in clinical practice. In the 1970s, homeopathy-considered in many circles to be a hypothesis-driven, fringe form of alternative medicine-became embedded into the training and practice of North American naturopathic doctors. Since the earliest days of its theory (circa 1800), homeopathy has escaped, and continues to escape, biological plausibility; however, the persistence of this modality (and the insistence by both its consumers and practitioners that it provides benefit) speaks to the role of expectations, beliefs, values, agency, context effects, and the placebo-at-large. It is our contention that the progression of professional naturopathic medicine in the 21st century requires a major transition in how it approaches the subject of homeopathy. We propose that students should be encouraged to critically analyze the tenets of homeopathy, its lesser known history, and the idea of homeopathy as a biomedicine that simply awaits untold chemicophysical mechanisms. Furthermore, the modality of homeopathy should be incorporated into the larger context of placebo studies, narrative medicine, ethics, and psychotherapeutic techniques.
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Affiliation(s)
- David H Nelson
- 1 Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | | | - Alan C Logan
- 3 inVIVO Planetary Health, Research Group of the Worldwide Universities Network (WUN), West New York, NJ, USA
| | - Martin A Katzman
- 4 The Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Bevan M, Ng YC, Cooper J, Robertson J, Walkom E, Chiu S, Newby DA. The role of evidence in consumer choice of non-prescription medicines. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:501-509. [DOI: 10.1111/ijpp.12546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/17/2019] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
To identify factors influencing Australian consumer decision-making and attitudes towards non-prescription medicine (NPM) purchases, pharmacy's role in providing these medications and views around sources of evidence for effectiveness of these products.
Methods
Cross-sectional survey of a general population sample of 1731 adults using an Australian online consumer panel stratified by gender, age and location (State/Territory). Beliefs about NPM purchases and evidence of their efficacy were assessed using a 5-point Likert scale (strongly disagree-strongly agree). Non-parametric measures (Ridit analysis and Mann–Whitney U-test) were used to explore associations between responses and previous experience with medicines.
Key findings
The most important factors when purchasing NPMs were effectiveness and safety. However, personal experience was the most common method of determining effectiveness. Most respondents believed buying NPMs in pharmacies gave access to advice, but were less likely to agree that pharmacies were associated with safe and effective treatments. Around half the respondents agreed that it is wrong to sell treatments lacking scientific evidence; many also agreed that it is up to consumers to decide what they want even without scientific evidence. Individuals experiencing an ineffective NPM were less likely to trust scientific evidence of efficacy as the sole source of effectiveness information; regular prescription medicine users often agreed that scientific evidence is needed to support effectiveness.
Conclusions
Consumers have conflicting views regarding the need for scientific evidence and the desire for patient autonomy in NPM purchases. This presents a challenge for pharmacists wishing to maintain professional obligations to provide evidence-based treatments to consumers.
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Affiliation(s)
- Marc Bevan
- School of Medicine and Public Health, Faculty of Health and Medicine, Waratah, NSW, Australia
| | - Yee Ching Ng
- Formerly School of Medicine and Public Health, Faculty of Health and Medicine, Waratah, NSW, Australia
| | - Joyce Cooper
- Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences & Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Jane Robertson
- School of Medicine and Public Health, Faculty of Health and Medicine, Waratah, NSW, Australia
| | - Emily Walkom
- School of Medicine and Public Health, Faculty of Health and Medicine, Waratah, NSW, Australia
| | - Simon Chiu
- Clinical Research Design and Statistical Unit, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - David A Newby
- Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences & Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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Reid R, Steel A, Wardle J, Adams J. Naturopathic Medicine for the Management of Endometriosis, Dysmenorrhea, and Menorrhagia: A Content Analysis. J Altern Complement Med 2018; 25:202-226. [PMID: 30383387 DOI: 10.1089/acm.2018.0305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To explore the recommendations of naturopathic medicine for the management of endometriosis, dysmenorrhea, and menorrhagia, drawing on traditional and contemporary sources. DESIGN Content analysis. SETTING Australia, Canada, and the United States of America (USA). SUBJECTS Contemporary sources were identified from reviewing naturopathic higher education institutions' recommended texts, while traditional sources were identified from libraries which hold collections of naturopathic sources. Sources were included if they were published from 1800 to 2016, were in English, published in Australia, Canada, or the USA, and reported on the topic. Included sources were as follows: 37 traditional texts; 47 contemporary texts; and 83 articles from naturopathic periodicals. RESULTS Across included sources, the most reported disciplines were herbal medicine, clinical nutrition, mineral medicines, homeopathy, hydrotherapy, and chemical-based medicines. Herbal medicines were extensively reported from all sources for the management of endometriosis, dysmenorrhea, and menorrhagia. Clinical nutrition was only recommended from contemporary sources for all three conditions. Mineral medicines were mentioned in both traditional and contemporary sources, but were only recommended for dysmenorrhea and menorrhagia. There were limited recommendations for homeopathy and hydrotherapy treatments in all conditions across all sources. Chemical-based medicines were only mentioned for dysmenorrhea and menorrhagia, and recommendations ceased after 1922. Recommendations for endometriosis were not present in any of the traditional sources, across all reported disciplines. CONCLUSIONS The findings of this article provide insights into the documented historical and contemporary treatments within naturopathic medicine for endometriosis, dysmenorrhea, and menorrhagia. While philosophical principles remain the core of naturopathic practice, the therapeutic armamentarium appears to have changed over time, and a number of the original naturopathic treatments appear to have been retained as key elements of treatment for these conditions. Such insights into naturopathic treatments will be of particular interest to clinicians providing care to women, educators designing and delivering naturopathic training, and researchers conducting clinical and health service naturopathic research.
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Affiliation(s)
- Rebecca Reid
- 1 Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,2 Office of Research, Endeavour College of Natural Health, Fortitude Valley, Queensland, Australia
| | - Amie Steel
- 1 Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,2 Office of Research, Endeavour College of Natural Health, Fortitude Valley, Queensland, Australia
| | - Jon Wardle
- 1 Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jon Adams
- 1 Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Prousky JE. Repositioning Individualized Homeopathy as a Psychotherapeutic Technique With Resolvable Ethical Dilemmas. J Evid Based Integr Med 2018; 23:2515690X18794379. [PMID: 30146897 PMCID: PMC6111390 DOI: 10.1177/2515690x18794379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The author puts forth the argument that the complementary and alternative medicine community should endorse specific aspects of the entire individualized homeopathic process, including its unique holistic consultation process, having dedicated lengths of time to enumerate the complete illness context, and the prescribing of homeopathic remedies, to reposition this modality as a psychotherapeutic technique. Moreover, placebo effects derived from homeopathic remedies could be used to further exploit favorable therapeutic effects that have accrued from the entirety of the homeopathic consultation process. The overall aim of this bold shift is to sustain the clinical practice of homeopathy from an ethical and clinically responsible (and plausible) framework that is properly evidence-informed.
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Zawiła-Niedźwiecki J, Olender J. A Not-So-Gentle Refutation of the Defence of Homeopathy. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:21-25. [PMID: 26732397 PMCID: PMC4823335 DOI: 10.1007/s11673-015-9682-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
In a recent paper, Levy, Gadd, Kerridge, and Komesaroff attempt to defend the ethicality of homeopathy by attacking the utilitarian ethical framework as a basis for medical ethics and by introducing a distinction between evidence-based medicine and modern science. This paper demonstrates that their argumentation is not only insufficient to achieve that goal but also incorrect. Utilitarianism is not required to show that homeopathic practice is unethical; indeed, any normative basis of medical ethics will make it unethical, as a defence of homeopathic practice requires the rejection of modern natural sciences, which are an integral part of medical ethics systems. This paper also points out that evidence-based medicine lies at the very core of modern science. Particular arguments made by Levy et al. within the principlist medical ethics normative system are also shown to be wrong.
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Affiliation(s)
- Jakub Zawiła-Niedźwiecki
- />Institute of Philosophy, University of Warsaw, Krakowskie Przedmieście 3, Warszawa, 00-097 Poland
| | - Jacek Olender
- />Institute of Philosophy and Sociology, Polish Academy of Sciences, Nowy Świat 72, Warszawa, 00-330 Poland
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Shaw D. A Strong Remedy to a Weak Ethical Defence of Homeopathy. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:549-553. [PMID: 26659862 DOI: 10.1007/s11673-015-9674-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/18/2015] [Indexed: 06/05/2023]
Abstract
In this article, I indicate and illustrate several flaws in a recent "ethical defence" of homeopathy. It transpires that the authors' arguments have several features in common with homeopathic remedies, including strong claims, a lack of logic or evidence, and no actual effect.
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Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
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Pickering N. When Lack of Evidence Is Evidence of Lack. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:545-7. [PMID: 26631232 DOI: 10.1007/s11673-015-9675-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/29/2015] [Indexed: 05/09/2023]
Abstract
In their recent article "A Gentle Ethical Defence of Homeopathy," Levy, Gadd, Kerridge, and Komesaroff use the claim that "lack of evidence is not equivalent to evidence of lack" as a component of their ethical defence of homeopathy. In response, this article argues that they cannot use this claim to shore up their ethical arguments. This is because it is false.
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Affiliation(s)
- Neil Pickering
- Bioethics Centre Te Pakapū Matatika Koiora, Division of Health Sciences, 1st Floor, 71 Frederick Street, Dunedin, 9016, New Zealand.
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