The Quackometer

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?

Labels: homeopathy, NHS

 

Reported today in Pulse,

Campaigners look to have lost their fight to save a leading homeopathic hospital, in a landmark case that accelerates the treatment’s deepening crisis over NHS funding.
West Kent PCT decided there was ‘not enough evidence of clinical effectiveness’ to justify funding routine homeopathic consultations and treatments at the Tunbridge Wells Homeopathic Hospital, a decision which may force its closure.

Amazingly, most patients and GP's did not want to see funding for homeopathy,

Campaigners against the cuts in West Kent applied for a judicial review last year . Although it was later dropped it forced the PCT to launch its own independent review. But this found 66% of patients and 80% of GPs did not support funding homeopathic services at the hospital, justifying the PCT decision to stop referrals for homeopathy.

It won't be long before the rest follow.

Dr Tim Robinson, a GP who provides a local homeopathic service in Dorset, said this was a ‘test case’ which would send ripples around the country. ‘The worry is that other PCTs may follow West Kent’s lead. The monies that are being spent on homeopathy compared with the NHS budget are small and are falling.’

Let's be clear. The Quackometer does not want to see homeopathy banned. It just thinks that spending public money on witchcraft cannot be justified in a modern social healthcare system. GPs may well still prescribe homeopathic remedies if they like and I do not have too much of a problem with this, but there ought to be a franker debate about the ethics involved in lying to patients about the pills. At the end of the day, people can still pop into Boots the Chemist if they so wish and pick up some sugar pills. Or even, if they are feeling brave, consult a lay homeopath. But the NHS does not have to pretend anymore that homeopathy works. A good decision.

Labels: homeopathy, NHS

 

Homeopathy, paid for by the NHS, is under threat. Millions of pounds of NHS money is pumped into a few Homeopathic hospitals so that patients can have 'choice'. It is a good thing, choice. The Queen makes this choice. The newspapers promote this stuff. It is natural. No side effects. Health Freedom. Patient Options. Blah Blah Blah.

Talking to people, with jobs and mortgages and only one cat, I get looks of surprise at my hostility to homeopathy. I think most people just do not understand what homeopathy is. They think it is like herbalism - natural extracts from plants that might cure the odd thing. After all, so many modern medicines have their origins in traditional herbs, why not homeopathy? Well, of course this is nonsense. Explain that homeopathic remedies might start out as herbs, but then they get diluted to the point where none of the herb remains, and eyebrows get raised. "Surely, most products in Boots aren't like that?". Well, pretty much, yes. You then explain the more bizarre elements (e.g. the more dilute the remedy the stronger it is) and the person either concludes you are a liar or makes a mental note to check this, or both. After all, we all know someone who swears by such stuff. They can't be wrong, can they? You might then discuss the futility of anecdote, the placebo effect, spontaneous remission, regression to the mean, wishful thinking, confirmation bias, and so on. By then, they have usually made their excuses. I am so interesting, it is amazing that I have so few friends.

Anyway, one aspect of homeopathy that does not get the coverage it deserves is the idea of homeopathic proving. Provings are the method by which homeopaths determine the effects of a particular remedy. In short, because 'like cures like' in the homeopathic world, if a substance makes you lethargic, then it can form the basis of a cure for tiredness. So a proving gives a group of volunteers substances that might tire you. Over a few weeks, diaries are kept of symptoms, dreams are recorded, star positions noted and poems are written. Afterwards, the investigators look through the diaries and record the experiences and conclude that the substance is now part of the suite of remedies.

It gets a little stranger, of course. Nothing is straightforward in the world of homeopathy. Hahnemann, the founder, started off using real poisons to do his Provings; making himself and his friends sick as dogs, blinding headaches, sweats and fevers, and so on. He found, funnily enough, that if you dilute the substance to non-existent levels, provings become a lot more palatable. In effect, you are now free to dream up whatever symptoms you want. Just as cognitive biases can convince you that homeopathy has cured you, cognitive biases can select particular symptoms as being significant. Provings are not done blind. Over the weeks you are going to experience a range of mental and physical states. This means that expectations can be set amongst the proving group, and availability biases, and selective thinking will ensure the proving gets the right 'result'. In summary, you should not confuse a Proving with proof.

Some more progressive homeopaths have had to admit that the whole concept of provings is deeply flawed. At Southampton University, Dr George Lewith has been working on the problems that such illogical and flawed procedures have:

Homeopathic pathogenetic trials (or provings) provide the foundations for the clinical practice of homeopathy. The most recent review of proving studies indicated that provings are generally of poor methodological quality. Methods to improve the quality and scientific rigour are needed to critically assess the clinical basis of homeopathy.

But few homeopaths take notice of such warnings. After all, they all have to undertake provings at homeopathy college and are indoctrinated to defend them. I can believe they are quite good fun. So over the years, many more substances have been drafted into the homeopathic fold through Provings. Given that remedies and provings rarely actually use the substance, doesn't that create a free for all? If the whole process is a delusion, what constrains the process and what substances are actually used?

I thought a competition would be good. Who could dream up the weirdest substance to use in a proving? Unfortunately, such a competition would be futile as the homeopaths are already doing it.

A good example of something I could never dream up is a proving of 'stone circle'. Carried out by 'very scary' Mary English RSHom, this proving took a piece of neolithic upright stone from Stanton Drew, near Bristol, and decided that a homeopathic preparation of rock was good for tiredness.

The longest serving director of one of the UKs' biggest homeopathy schools, Misha Norland, does a lot of new provings with his students. He is quite prolific. Here is a list of some of his provings:

• AIDS
• Trained Peregrine Falcon
• Positronium
• LSD
• Heroin
• Buckyballs
• Bewick Swan
• Condom
• House Sparrow
• Cockroach

That is going to take some beating. The positronium one is interesting. He is obviously quite proud of his antimatter homeopathy remedy. The AIDS remedy was taken from the blood of a man who died.

The sky is the limit for provings. I am sure you can Google your own. But here are a few:

• The light captured from Venus.
• Camel's milk.
• Plutonium
• Vacuum Cleaner Dust
• Caviar
• Tyrannosaurus Rex

It would be easy to think that this stuff is just on the fringe of homeopathic thinking. Indeed, the sheer incredulity of it is what allows homeopathy still to be funded by the NHS. This just cannot be true. But, one only has to visit the web site of UK homeopathy pill manufacturers to be reassured that this is not off with the homeopathic faeries. This is mainstream.

Let's look at Helios, one of the UK biggest fake pill manufacturers. They list their remedies by initial letter. Let's pick, at random, H. Remedies include,

• Hadrian's Wall
• Helicobacter Pylorii
• Helium
• Hepatitis A, B and C.
• Halogen Light
• Hyena Saliva

There are dozens of these, and this is just H. Feel free to explore the other letters.

So, should the NHS pay for Hyena Saliva? Well, if they are, what is sure, is that they are not getting any. For all pratical purposes, all homeopathic pills are identical: no active ingredient.

If I was running Helios, I would have a big skip of blank pills out the back. When an order came in, I would scoop up some pills into a pot, print out a label, stick it on, ship it out, and no one would be the wiser. There is not a diagnostic test in the world that would tell you whether you really had Hepatitis B or if you had Bewick Swan. You might think you are taking caviar but really you could be sucking on condom. Is your medicine really the dog's bollocks? No instrument in the world is sensitive enough to convict me in court of defrauding you.

And this is what your taxes are supporting. The NHS, by providing Homeopathy, is legitimising this fraud. The NHS is funding witchcraft. Dr Peter Fisher, the clinical director of the London Homeopathic Hospital and the 'respectable' face of homeopathy defends this voodoo. He may appear to make reasonable statements about homeopathy, but looks as if he is out of touch with mainstream practice.

Witchcraft does not belong in the NHS. It is not adding to patient choice. People are being conned, deluded and harmed. Let your MP know.

Oh, and if you can think up an even weirder substance to do a Proving on, please post below.

Labels: homeopathy, NHS, Society of Homeopaths

 

A press release today from the Economic and Social Research Council talks about recent research on how the public evaluates the information on health websites. The concluding message is simple:

Labels: boots the chemist, NHS, pseudoscience