Desperate Remedies

Homeopathy on the NHS has nearly vanished. We see prescriptions have halved in the past two years and one of the last five hospitals has been confirmed to close. This is as it should be. The last vestigial remnants of nineteenth century quackery in the state health care system are being dropped from the tax payers burden. There is nothing unsurprising here. It is the natural result of an increasing awareness of the need to adopt evidence based practices. As much as quackbusters would like to think that it is their influence that has achieved this, I would guess what we are seeing is the result of more general and broader historical changes.

But the homeopaths, in their fabulously constructed fantasy world, see an army of quackbusters crossing the Vistula and are conspiring in their bunkers to strike back with what depleted reserves they have. We can expect to see increasing and bizarre attempts by homeopaths to bolster their position and smear their enemies.

The Faculty of Homeopaths, who represent medically trained homeopaths, has been hard at work. It has issued a press release reporting supposedly dramatic benefits for NHS homeopathy. ‘Angry’ Melanie Oxley, ex Society of Homeopaths, appears to be issuing press releases for the Faculty.

In one press release, she tries to discount reports that doctors are not prescribing homeopathic pills any more. She says there are three reasons:

Although balanced by increased patient numbers, the proportion of prescriptions actually written by a GP is not representative of the whole; other health professionals such as nurses and pharmacists have prescribing rights.

Of course, the Faculty do not appear to have any evidence that there is a massive shift to nurse based prescribing of homeopathy within the NHS. That would be fascinating in its own right.

The cost of buying a homeopathic medicine over the counter is often less than for a NHS prescription (prescription £7.10, homeopathic medicine typically less than £5.00). Increasingly, prescribers are recommending their patient buys the
remedy over the counter, saving the patient money.

This may well be true, but many people on long term illness, the young and the old, do not pay prescription charges anyway. Again, there is no evidence to support the assertion that doctors (or nurses) are asking patients to cough for their own sugar pills.

Only a tiny proportion of the 3,500 plus homeopathic medicines available are listed in the computer software for GPs, and so most homeopathic prescriptions are handwritten. It is not clear whether these are entered into the data.

Mmmm. The computer says, ‘No’. Yes, there are thousands of remedies, but most prescriptions are undoubtedly for the common dozen you can find anywhere. Is the NHS really prescribing hyena saliva and Vacuum Cleaner Dust remedies? I doubt it.

The latest piece of rubbish to emerge from the Faculty is about a paper that has just been published from research at the Bristol Homeopathic Hospital in the Faculties comic, Homeopathy. This follows the appalling ‘Spence’ paper from Bristol that claimed to show that 70% of their patients reported health improvements. There were no control groups in this study. There was no evidence that homeopathy was the cause of the health improvements. It was rubbish and Bristol have not learnt the simple lesson.

This time we learn that “Nearly 60% of patients who had received a series of homeopathy appointments reported an improvement in health that affected their daily lives.” Again, nothing to compare this figure to. No way of knowing what the health improvements would have been without homeopathy. We just find out the startling truth that some ill people get better. But this is unsurprising as the paper was about a pilot study to test methods in quality assurance in homeopathic hospitals. It is a way of conducting homeopathic customer satisfaction surveys and tells us nothing about the effectiveness of the magic sugar pills.

But being good PR people at the Faculty, the truth will not get in the way of a good story. The Daily Mail has already reported on this nonsense, The alternative Holby City that treats 30,000 patients a year.

The Mail says,

But with budgets in crisis, critics claim spending on complementary medicine is frivolous – and last week it was revealed that GPs’ homeopathic prescriptions have fallen by 40 per cent in two years.

Yet according to the journal Homeopathy, among those receiving these remedies, 60 per cent say their health improved after treatment. We spoke to a range of patients at the hospital who have turned to homeopathy.

In other shock medical news, children who have visited hospital tend to grow taller over the following year. And so, the Mail trots out the anecdotes. In one hilarious one, a patient recounts the failure of homeopathy,

Dr Saul Berkovitz, who leads the clinic, put me on homeopathic remedies at first – causticum, which is supposed to help stiffness, and cimicifuga, which alleviates aches. Neither helped.

But never mind. Some chinese herbal medicine was the thing that ‘worked for her’ in the end. We also find out how Gertrude does not get colds anymore and how Joshua’s childhood eczema cleared up. Also, in a remarkable testimony, Nike Jonah’s headaches have been helped by real medicine, but now she has taken some homeopathy and is waiting to see if it works. And 95 year old Jane swears by arnica for her bruises. You could not make this stuff up.

The Faculty of Homeopaths are taking entirely the wrong track here. They are swimming against the current of science and reason. As the (relatively) sane wing of the homeopathy movement, the Faculty really ought to be having a frank discussion about the practicalities and ethics of using an entirely placebo based therapy in modern healthcare. That is what all the science and evidence says homeopathy is and that is the only discussion that could feasibly save homeopathy on the NHS. Can they muster the insight and courage to have that conversation?

On this theme…

26 Comments on Desperate Remedies

  1. All the prescriptions I have seen, thankfully not that many lately, have been computer-generated.

    One of my colleagues gave patients the same homeopathic product whatever the prescription said, the logic being it was so diluted that all the tablets were essentially the same Lactose blanks. Over a many year period not one patient noticed.

    Unprofessional, maybe, but still quite amusing.

  2. The first anecdote from that Daily Wail story is a brilliant endorsement of homoeopathy:

    “I first came here in July 2005. Dr Saul Berkovitz, who leads the clinic, put me on homeopathic remedies at first – causticum, which is supposed to help stiffness, and cimicifuga, which alleviates aches. Neither helped. We then tried phosphorus – but that didn’t work.

    It was only when I was put on a cocktail of herbal medicines including Rehmannia, Bupleurum (both Chinese herbal preparations), black cohosh, celery seed and liquorice root that I began to notice any effect. After a month or two of taking it I began to feel less stiff.”

  3. All the prescriptions I have seen, thankfully not that many lately, have been computer-generated.

    Well the doctors software should have the varying brands of sugar pills on it, the data should be compliant with the Dictionary of Medicines and Devices so it should be possible to get an electronic script for it

  4. Mojo. This Boiron recall was for MOTHER TINCTURES ie alcohol extracts of plant. The French still call these ‘homeopathic remedies’ as they are prescribed on a like cures like basis. They are NOT dilutions and I assure you that Gingko and Equisetum MOTHER TINCTURES produce very nice TLCs and can easily be differentiated from one another.
    Anyone can make a mistake it seems.

  5. What are the homeopaths complaining? With the prescriptions halving, that would only imply they would become stronger.

  6. @ChemistIntheknow?

    That’s what I thought as well, but see the comment by DMcILROY on Nov 11, 2007 at 5:36 pm on the page I provided the link to.

  7. “We also find out how Gertrude does not get colds anymore and how Joshua’s childhood eczema cleared up.”
    Nice. Dr Tony Copperfield, talking about the Guide for Patients published by the Prince of Wales Foundation for Integrated Health, said this of homeopathy: “The fact that it’s so useful in managing pathologies characterised by spontaneous remission and a high placebo response is obviously just a coincidence.”

  8. Mr Hunnybun,

    I would be very shocked if all pharmacists were not dishing out the same homeopathic remedy no matter what was prescribed. Anything else would be an unforgivable waste of tax payers money. I would hope each pharmacy had a big tub of lactose pills, dipped in a little pill bottle and then printed out the ‘correct’ label. The Society of Homeopaths has testified to the House of Lords that the only way to tell the pills apart is by the label.

    The homeopathic ritual of repeated dilutions and bashing on a leather bible has absolutely no effect on the end product. It is redundant in the production process and so if the NHS is to achieve proper efficiency here, these steps could safely be dispensed with. Your ‘unprofessional’ colleague is ahead of the game.

  9. Black duck- You must be happy with helping to reduce the expenditure on homeopathy from 0.005% to 0.004%

    I feel that you are wasted though and that your group could campaign to save some heaps more money and lives too.
    As you know 4% of conventional treatments are ineffective or harmful.
    Ref http://clinicalevidence.bmj.com
    46% have unknown effects.

    How about using your influence to sort out these 50% of treatments.
    Or is it slagging homeopathy so much easier- and more fun.

  10. JohnChemist – your reference points to no such figures. If you would care to point to a real reference for your figures it would delight me to show you how daft your arguments are.

    Can you point to real figures? Do you know what you are talking about?

  11. (Based on observations, add appropriate salt)

    I’d also add that homeopathy is probably the most recognised Alt-med in the average consumers mind, fractionally leading dietary crap but only because that seems to change every year.

  12. 2007-08 spending on the NHS is £92 billion.
    For JohnChemist this is £92,000,000,000

    0.001% is £92,000,000. Not a figure to be sniffed at. For instance this is 92 MRI scanners. So well done le Canard Noir

    That leaves another £368,000,000 to be recovered and spent on something useful instead.

  13. Le canard noir
    I assumed that you knew this site well. Please go to.
    http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp
    Please advise me if this data from the clinical evidence journal is wrong. Maybe you could comment on whether or not they know what they are talking about.
    I didnt think that this was a matter of argument.
    I am of course pleased that most drugs are reported as effective.

    Nash
    0.001% of 92 Billion is 920,000 not 92,000,000
    This 0.001% refers to the drugs budget so would be much less than 920,000.
    Still the money saved could always be spent looking at those 4% ineffectual harmful treatments clogging up the Pharmacy shelves.

  14. If some of you want to believe that 0.001% of 92 Billion is 92 million and increase the homeopathic budget by 100 times then fine.
    If some of you want to believe that all the non homeopathic 99.995% prescriptions are all proven treatments then fine.Go to:-
    http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

    Let us extend this requirement for proof to all treatments – I am sur ethat you all want that?
    Put it another way there are approx 50,000 homeopathic prescriptions per year that must come to around £500,000.
    Should it turn out that this figure is 500 million for 50,000 prescriptions then I will be contacting the NHS fraud line along with the black duck.

  15. JohnChemist your were the one to introduce the figure of 0.001%

    “Black duck- You must be happy with helping to reduce the expenditure on homeopathy from 0.005% to 0.004%”

    Now to me 0.001% is 1/1000, first decimal place is ten, then hundreds and finally thousands!

    92 billion is ninety two thousand million, dividing this number by one thousand is easy, simply remove the thousand and you are left with ninety two million. You seem incapable of actually using a calculator so maybe words will help.
    This is not my belief this is fact.

    Now the NHS budget is 92 billion, the drugs budget is 9.965 billion (in 2004/5) which figure do you want to use. Either way 0.001% of it is a lot of money.

  16. I also just noted that 92 million magically became 500 million. Is this a standard homoeopatic multiplication of any number?

  17. Jayceeel
    Nice try to wind me up. This is quite amusing though.
    0.001% is 1/100000
    Lets take this slowly.
    If 1% is 1/100
    0.001% must be 1/100000 not 1/1000 which you point out as fact.

    Again if you wish to delude yourself that the homeopathic budget is 100 times greater than it is then fine. I would only suggest that you check this out with someone else.
    Your calculations would make the homeopathic NHS drug budget around 50 million for 50,000 prescriptions- Thats £1000 per prescription.

  18. John – you may have a basic grasp of percentages, but you have a far more shaky grasp of comprehension and evidence.

    By citing the BMJ clinical evidence site, you really are being a bit thick and hypocritical.

    Let’s take this slowly.

    Firstly, you assume that the article is talking about ‘conventional’ treatments. It does not say this. We know the NHS commonly employs many dubious techniques – including homeopathy, reiki etc. It also uses many techniques, e.g. the variants of counselling techniques, that do not have sound evidence bases. And, yes, pharmacies are full of quackery too. The point of the BMJ site is to highlight these areas and to persuade researchers to develop evidence bases.

    As for homeopathy, we have an overwhelming evidence base and it it places the technique firmly in the ‘does not work’ box. This is only now disputed by those that profit from homeopathy and are prepared to misrepresent the science.

    By ignoring evidence, Homeopaths are now systematically incompetent in their practice and so by bringing up the BMJ site, you are being thoroughly hypocritical.

    For me, the absolute expenditure on homeopathy on the NHS is immaterial. (But good estimates place it much higher than you might think, when all the hospitals, doctors’ and GPs’ time and support is taken into account.)
    What homeopathy on the NHS represents is far more dangerous. It is the rejection of the approach espoused by the BMJ clinical evidence site – that clinical decisions should have the best evidence available to inform them and that public spending decisions should be based on the best evidence and not paternalistic judgement, politics or wishful thinking.

    Am I right John Chemist? Would you like to declare your interests? Do you have a large material interest in keeping homeopathy on the NHS?

  19. Le canard noir
    I declare financial interests (shares)in Glaxo, Astra, Shire. I wont bore you with those on the AIM index that I have an interest in. Well- when Glaxo went less than 1000 and Astra less than 2000 how could I resist? I have worked in the pharmaceutical industry and I enjoyed it. Like you some homeopaths would call me a hypocrite. I dont care- I have met lots of good people in both the pharmaceutical industry and in homeopathy and I dont go along with all this stereotyping of one and everybody in it being all good and the other where everyone is all evil.

    Homeopathy on the NHS has a negligable effect on my income but I do earn some money through homeopathy.
    I do however support homeopathy on the NHS.

    As for your explaination about the clinical evidence website I will just repeat that 46% are of unknown
    efficasy and 4% ineffective. If you think that most of these treatments are non conventional treatments then that is your opinion. The situation is clear to me and to people I speak to.
    Add Clomifene Citrate and intrauterine insemination to another two ‘effective treatments’ previously given instead of the effective IVF.
    This sort of thing should not be happening.
    My point was only to ask why you are spending so much time on homeopathy when it has such a tiny part of the budget.

    It is your blog though and you can write whatever you like as far as I am concerned. You sure have a lot of anger and venom for homeopaths. I dont suppose that SOH action last November helped?

    Funny how homeopathy is so popular among Pharmacists and Drs in France and Germany. Lots seem to believe the huge amount of research from the Boltzmann Institute.

    It is quite an easy ride for you here.
    You may be able to influence the future of NHS homeopathy but the principal effects on UK homeopathy will be driven from Europe.
    In future some things you will like and some things you wont like. Same for me.
    I hardly expect you to change your views from what I say. If you think that I am thick because I dont change mine then I have been called worse.
    Thank you for agreeing with me the % issue.
    However, I warn you that this may not be the last time that we reach some sort of an agreement.

  20. JohnChemist: it’s good to see such polite disagreement!

    I’ve been thinking about your question, about why quackometer might focus on AltMed rather than the well recognised deficienies of medical practice. I think the answer might be that medicine is often mistaken in practice, while homoeopathy (for instance) is mistaken in principle – in other words, its founding principles are demonstrably false. Then too, medicine has self corrective mechanisms which (slowly and painfully!) correct errors, while homoeopathy is resistant to self-testing and correction. Finally, a blog is an activelt selected view – I don’t think you could conclude that the quackometer author is in favour of medical error, or doesn’t think they are also significant.
    (BTW I didn’t understand your point about IVF – could you clarify it for me?)

  21. What a boring & pointless load of rubbish this page is.

    And while you carry on with the bickering about how many zeros you have on the end of your figures, and whose number is bigger than the other, perhaps you could excuse the rest of the population whilst, in the meantime, they go and get themselves cured – with homoepathy.

  22. Nice Posting and nice discussion guys. but it will be more better if you share info instead of arguing with each other. thanks

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