It’s hard to predict which would be more disconcerting: finding out that your doctor believes in notions that defy basic science—like, the pseudoscientific doctrine of homeopathy—or that they’ll prescribe you something they know doesn’t work in hopes you’ll be tricked into believing you’re better—achieving nothing more than a placebo effect.

It might be a toss-up of which is worse. And if you get a homeopathic prescription in Switzerland, it’s also a toss-up of which kind of doctor you’re dealing with.

In a large survey of physicians around Zurich , only 50 percent of the doctors who prescribed homeopathic treatments did so firmly believing that they were treating their patients’ ailments. About 21 percent of doctors who prescribed homeopathic treatments did so explicitly to achieve placebo effect. And the rest provided incomplete responses or reported ambiguous intentions behind their dubious prescriptions.

The divided findings, published recently in the Swiss Medical Weekly, raise questions about why some doctors buy into homeopathy despite having scientific training, while others would prescribe homeopathy when they don’t expect specific effects.

The authors of the study, led by Stefan Markun of the University of Zurich, also say the findings suggest two paths forward: “Educational efforts should therefore address not only the evidence base of homeopathy, but also ethical dilemmas with placebo interventions,” they concluded.

Dilute or delude?

In Switzerland—like many other places in the world—homeopathy has a devout following and is even integrated into national health plans. Markun and colleagues conducted the survey to try to figure out why classically trained doctors turn to the pseudoscience. This information, they argued, could “foster a productive dialogue and discuss the role of homeopathy in real-life clinical practice.”

The researchers sent out surveys to all practice-based physicians in the Swiss canton (member state) of Zurich in late 2015. The 24-point survey covered basic demographic data of the doctors and the doctors’ beliefs about homeopathy and its tenets, as well as if, when, and why they use it. A little more than 1,500 doctors filled it out, which is about a 38-percent response rate.

Overall, about 23 percent (345 doctors) reported having prescribed homeopathic treatments or referred patients to homeopaths within the 12 months prior to the survey. This was dubbed the “prescribers” group. The types of doctors most strongly linked to dabbling with the quackery were pediatricians, gynecologists/obstetricians, and those without a specialization.

While 50 percent of ‘prescribers’ used homeopathy with the intention of treating their patient’s specific ailments, only 42 percent or so bought into the homeopathic idea that the treatments worked because of the ‘law of similars’ (like cures like). That’s the idea that a (heavily diluted) substance that causes similar symptoms to a disease can cure that disease.

Only about 27 percent strongly bought into the principles behind homeopathy, including the miasm theory that "noxious influences" cause diseases. And only 19 percent bought into more modern twists, such as the incomprehensible idea that water molecules can have memories.

About 35 percent of prescribers said they thought homeopathic treatments only worked because of placebo effects. On the flip side, around just 23 percent of prescribers thought there was adequate scientific evidence to back up efficacy of homeopathic treatments.

Prescribers were most likely to endorse homeopathic treatments either when symptoms were vague and a clear cause couldn’t be identified or after conventional treatments failed. But among both prescribers and non-prescribers, 71 percent of survey takers agreed that homeopathy could effectively generate a placebo effect.

“These findings possibly reflect a certain openness of most physicians to accept homeopathy as a placebo intervention,” the authors concluded. “This, however, also points to the need for specific and practicable ethical guidance, which will assist physicians who risk being perceived as deceitful by their patients.”

Swiss Medical Weekly, 2017. DOI: 10.4414/smw.2017.14505 (About DOIs).