Homeopathy from the NHS?

Should homeopathy be included on the NHS? Most of us would say no, simply because we do not believe the evidence supports the basis on which homeopathy is claimed to work. “Like cures like” is possible enough – indeed, it sounds very similar to the basis on which working vaccines to diseases like flu are created. But the process of diluting – succussing – homeopathic remedies that progressively removes more and more of the original active substance from the sugar pill/water/alcohol substrate clearly is at odds with everything we know about how chemistry works.

Through the miracle of the Internet, I spent part of this afternoon sitting at my desk watching live video from the House of Commons Science and Technology Sub-Committee as they debated the question above. The detail of the witnesses: Rt Hon Mike O’Brien QC MP, Minister of State, and Professor David Harper CBE, Chief Scientist, Department of Health, and Professor Kent Woods, Chief Executive, Medicines and Healthcare Products Regulatory Agency.

The main justification for including homeopathy appears to be its popularity: 10 percent of the population use these remedies. (By this logic, smoking should be included on the NHS!)

One of the committee members asked about the disparity in the rules, in that homeopaths don’t have to prove the efficacy of their remedies, but the manufacturers of vitamin supplements do.

Some other interesting questions were raised. Is it acceptable for a doctor who knows that a homeopathic remedy has no effect other than the placebo effect to dispense these remedies to patients on the basis that they might work. Should he be required to disclose to the patient his knowledge that they are no better than placebos? Most patients would probably resent this kind of “paternalistic deception”.

Besides, the minister said later, it’s “illiberal” to refuse people treatments they believe are working. He drew a distinction between efficacy (evidentially proven) and effectiveness (helps patients). Some numbers: 88 PCTs do not provide homeopathy, 26 do in exceptional cases; 31 do. (I think those hastily scribbled numbers are right.) NICE does not consider the evidence base sufficient to assess these remedies.

There seems to have been some (now sadly typical) trouble over the consultation on the subject of introducing rules for homeopathy, in that although it was opposed by several eminent medical bodies the recommendation that eventually reached the minister was that there was widespread support. Professor Campbell replied that the debate is about homeopathy, but there were few objections to the scheme itself. The committee asked him to make the consultation testimony public. “This is a homeopathic medicinal product used within the homeopathic tradition” is the wording on the label; what does this mean to the “average man in the street”? Doesn’t it imply the stuff, you know, works? (I’m paraphrasing; the questioner managed the most polite version of “Isn’t this a lie to the public?” that I’ve ever heard.)

I can’t answer that personally, but I can recount the argument I had recently with an American friend. It went like this:

The Royal Family uses homeopathy and look how long they live!

The Royal Family is one of the richest families in the world, and besides homeopathy they use all the best medical care their money can buy.

They do?

Homeopathy isn’t harmful in and of itself. Its wider effects – a lack of care for evidence and the truth, diverting people from medicine that works (it has been recommended as an anti-malarial drug), and the promotion of general ignorance – are harmful.

(Ben Goldacre also featured in a previous session, of which a webcast can be seen here.)

3 thoughts on “Homeopathy from the NHS?

  • Monday, 30 November, 2009 at 18:55
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    I e-mailed Andrew Lansley (Shadow Secretary of State for Health) about his view on using alt medicines in the NHS. His response:

    Dear Tom,

    Many thanks for your email to Mr Lansley. It is estimated that about half of GPs refer some patients to alternative therapists. There are currently five NHS homeopathic hospitals in the UK and you must be referred to these by your doctor. We are aware that there are differing views on the provision of homeopathic remedies, with some arguing that there is not enough evidence to support their availability via the NHS, while others argue that greater access to complementary therapies in the NHS might lead to widespread benefits.

    Conservatives see the most effective method of making decisions about what the NHS provides as the cost-clinical effectiveness criteria, which the National Institute of Clinical Excellence (NICE) undertakes in the decision-making process on drug regulation and use. NICE believes that homoeopathic medicines should be treated in exactly the same way as traditional medicines in terms of deciding whether the NHS should provide them to the public.

    In the case of the public being free to buy herbal remedies, the Conservatives have always said that, as long as a treatment has been proven to be safe then it should be available to buy. Consumers are then free to assess the effectiveness of the treatments which they purchase.

    Consequently, we believe that homeopathy and alternative treatments are a valuable resource for doctors to be able to draw upon when offering treatments. Where a doctor and a patient believe that a homeopathic treatment may be of benefit to the patient, I believe doctors should be free to prescribe that medicine. All therapies should be considered equally, and decisions on whether or not to provide them on the NHS should be evidence-based, as is the case with all other conventional medicines and treatments.
    kind regards
    Connie

    Connie Sturgess
    Office of Andrew Lansley CBE MP
    Shadow Secretary of State for Health

  • Wednesday, 2 December, 2009 at 11:07
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    And there’s me thinking the longevity of the Royal Family was due to us all singing to the gods to Save Our Gracious Queen…

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