The Northern Ireland NHS Alternative Medicine ‘Trial’

Various news sources and pro alternative medicine web sites have been telling us this week that a trial involving NHS GPs in Northern Ireland has shown that referring patients for homeopathy, reflexology, acupuncture and other CAM has highly successful outcomes. I see this as nothing short of an attempted fraud to extract NHS money for traders in quackery. Let me explain.

For example, the Princes Foundation for Integrated Health tells us, “It has demonstrated that integrating complementary and conventional medicine brings measurable benefits to patients’ health”. This is a deeply misleading statement and it does not take much to understand why. To do so, let us imagine another experiment.

In our imaginary world, the Apple Marketing Board approach the NHS and ask for £200,000 to do a study to show the truth behind the statement “An apple a day keeps the doctor away”. The Minister, being particularly fond of apples, agrees and the study begins. A group of doctors, who are also apple eaters, agree to send selected patients for apple therapy. They will treat them as normal, give them advice and drugs, or refer them as they normally would, but also offer to send them to receive a daily apple from an apple therapist. Patients who also like apples agree and they are tested to see how they feel now, in the doctor’s surgery, and how they feel a few months later after they have taken their normal medicine and also eaten their daily apple.

It is not difficult to predict the outcome of this test. Undoubtedly people will report being better months after their initial visit to the doctor. People go to their GPs when their health is bad. Through the natural progression of illness, or through the effectiveness of conventional treatments, people will undoubtedly report being better at a time in the future. Even people with chronic conditions will, on average, report feeling better as the first measurement in the GP office was taken when it is very likely symptoms were bad. (People with chronic illnesses do not go to their GP quite so much when their symptoms are not too bad.) Some patients may even experience a placebo effect from the obviously pleasant and indulgent experience of feeling special and being given apples.

Only a fool would conclude that any reported improvements were due to apple therapy. From this study, we have no way of comparing apple eaters with people who did not eat apples. Simply proclaiming health improvements is not enough as that is what we would expect without any apple intervention. We would also expect GPs to largely be happy and patients to be happy with their apples as they selected themselves into the trial as they were predisposed to enjoying apples. We cannot conclude that all people would be similarly so grateful. We might quite rightly conclude that the whole thing is a PR stunt by the Apple Marketing Board.

But this sort of result is exactly what we see in the Northern Ireland study. There has been no scientific publication of the study. Instead, the groups behind the study have commissioned a market research company to compile lots of meaningless tables and graphs for them. And the obedient market research company has produced a report that shows that, basically, people get better after visiting their doctor and that they quite like the indulgence of alternative medicine.

Alternative medicine groups are now ecstatically happy. This should not be a surprise to them as they were in control of events all the way along. What is quite remarkable about this so called study is that the money to conduct the trial was given to a lobby group for promoting the inclusion of alternative medicine in the NHS. It is difficult to imagine any other area of government where a group with large vested interests was given permission to promote their business, under the guise of science, using tax payers money. Independent, this report is not.

Peter Hain, the then Northern Ireland Secretary and supporter of quackery, gave the money (£200,000) to an outfit called GetWellUK. GetWellUK, run by Boo Armstrong, is a private company specifically set up to be, in their words “the best supplier of complementary healthcare to the National Health Service.” Only a fool would think any dispassionate appraisal would come out of such a lobby group. Indeed, at the time, Professor David Colquhoun pointed out that the project was a farce,

At the end of the “pilot scheme” there will have been no proper assessment of the effectiveness of the treatments. We shall be none the wiser.

And that has come true. The analysis has come from a market research company called SMR, run by a chap called Donal McDade. It is not a scientific analysis. It is at best a customer satisfaction survey. At worst, it is a set of graphs and figures that will please SMR’s clients – GetWellUK – so that they can use it for misleading PR.

The report avoids all the important questions. Primarily, it would be useful to know if the therapies were effective. On that matter it is silent. It asserts that the therapies provided significant health gains and produced economic savings:

Given the evidence of health gain documented by patients, GPs and CAM practitioners, it is recommended that DHSSPS and the project partners explore the potential for making CAM more widely available to patients across Northern Ireland. Not only has this project documented significant health gains for patients, but it has also highlighted the potential economic savings likely to accrue from a reduction in patient use of primary and other health care services, a reduction in prescribing levels and reduced absenteeism from work due to ill health.

There is absolutely no evidence in the 146 pages of guff in this report to make that assertion. It is pure wishful thinking.

Of course, patients were going to report their pleasure with the therapies. People do tend to enjoy the pampering of alt med. But that does not mean that quackery is effective or economically efficient. I would love my GP to send me to a weekend country spa resort after each visit to her, and undoubtedly I would feel great about it. My health would improve no end – at least that is what I would tell the market researchers. But this is not France.

GetWellUK do not address the question of effectiveness for one simple reason. We already now how effective the treatments being considered are. Homeopathy is pseudoscience, magical thinking and a placebo. Acupuncture appears to be nothing more than a theatrical placebo too with limited evidence of any real effect. Reflexology is just plain nonsense and little more than a foot massage with some mumbo jumbo thrown in. Chiropractic and Osteopathy are useless for everything but lower back pain, and then no more so than a conventional (and cheaper) options. But of course to discuss these things, would be destroy the value of this report as propaganda.

It is difficult to forgive GetWellUK for this as there is a precedent here. In the Spence study of 2005, the customers of a homeopathy clinic in Bristol, were asked to rate their experiences. It was a simple customer satisfaction survey but written up as a test of the medical effectiveness of homeopathy. The report was berated for its unscientific approach and for its use as commercial propaganda. The Northen Ireland team must have known the weakness of such an approach. Or was there aim simply to produce good PR so they could push their quack agenda into the NHS?

And the PR is showing some signs of working. The survey got a free ride in the GP magazine Pulse. It also attracted a comment from a Pulse journalist who demanded that Professor Edzard Ernst hand over his £10,000 prize as it was now clear that homeopathy ‘worked’. The journalist simply showed himself to be a fool. The Ernst-Singh prize has simple winning conditions that are far from met in this shabby report.

No doubt the various quack pressure groups will be using this to promote their agendas. If this was a building firm bidding for a government contract, no doubt submitting such a misleading report would ensure they were barred from future tenders and maybe even prosecuted for fraud. But this is alternative medicine. It is not socially acceptable to call a fraud a fraud when it deals with quackery. And behind all of this, of course, funding GetWellUK, is our future head of state Prince Charles.

Michael McGimpsey, the Health Minister in Northern Ireland, has now had this report on his desk for quite a few months. The government web site describes this as an ‘independent report’ . It is anything but. Let us hope he has the wisdom to see through this charlatanism and let the report get buried under a mound of more pressing issues.