Experts attack 'ill-conceived' plans for patients to buy homeopathy on the NHS

I'm in favour of patient choice provided we're not wasting money.

In comparison to the vast amount spent on the cocktails of expensive medication that is never even taken by patients and provides little benefit if it is, the amount spent on complementary therapies including homeopathy would be miniscule, so the cost argument fails. Patient choice has to be paramount. Who's life is it anyway?

Does that mean that it is 'your' money? Ernst's money? NHS 'experts-bureacrats' money? Government money? Or does the money come from patients? From taxpayers? Having paid for it, and being entitled to medical treatment, if I want homeopathy in preference conventional medicine does that mean I cannot have it - because ConMed experts tell me there is no evidence? I can spend my money on any house, any car, any holiday I want, as long as it is safe. So what right does anyone have to choose for me how I am to be treated when I am ill? It is vested interests talking here. Pharmaceutical drug treatment has had a cosy monopoly within the publically funded NHS for too long. Now patients are being offered choice, and many of them, including myself, want it.

This is not just about cost. It is about a public health service that provides services that are obvious quackery. It is about the ethics of providing sugar pills and telling patients they have magical effects.

Simple really. Principle of homeopathy is that you give a miniscule dilution of a substance that mimics the pathological symptoms and magically the patient is cured. Diluted with water, it is postulated that the mere contact with the active substance has altered the properties of the water to be therapeutic. However, the water will have been through several people's alimentary tracts before - and perhaps been in contact with the contraceptive pill. Does this make homeopathy a fertility treatment? It's total bunkum and hocus pocus and I marvel at the credulity of people who believe in it in a quasi-religious fashion. I have no problem with people spending their own hard-earned on it but the limited tax-money (yes I know where it comes from!) should be spent on evidence based and provable treatments in a cash-limited service.

What is implied by this discussion is that common orthodox medical interventions are routinely based on evidence. Nothing could be further from the truth. The BMJ's handbook on clinical evidence clearly shows that a mere 12%(sic) of common treatments have evidence to say they are definitely beneficial. Another 23% are of 'probable benefit' and as for the rest... Here is a simple pie chart showing this. http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp Now in the light of these statistics about ordinary medicine, is it fair or ethical to use evidence based medicine as a blunt instrument to bash homeopathy and alternative medicine, exclusively?

Does that mean that patients will be able to have Alexander Technique lessons (for which there IS an evidence base...see www.bmj.com, click on 'research' and then search 'Alexander Technique')... funded by the NHS? Dr M Wohl

The comments about the low cost of homeopathic treatment only apply to the preparations themselves. Costs to attend the clinician for assessment/ monitoring are going to be similar to conventional treatment. As I am in an area to be piloting patient held budgets, the argument of choice vs efficacy/risk is very real. What do we do if 1) The patient 'chooses' to have a potentially harmful treatment. Should we fund? 2) They spend all their budget on alternatives leaving no money to provide conventional care. Should we bail them out or leave them to sufffer the consequences?

Dear all Who will start the offer of funding for more research into complementary medicine?!?! Roll up, roll up - can I start the bidding at 5 million from the Welcome Trust.

I never found suggesting alternative medicine ever worked but lots of patients enjoyed rubbing my nose in the **** having been to an alternative practitioner behind my back. Let's face it, medicine was regarded as an 'art' until recently and we do not have all the answers. Patients percieve alternative practitioners take better histories and do more thorough examinations - we are back in the chaperone age for fear of being accused of assault. Just don't make it too easy so they feel the fight makes it worthwhile. I am cynical and retired from clinical practice.

Doesn't your guest editor use CAM including homeopathy in his practice? Should we not hear his opinion on this newsworthy matter?

Andy and Peter - it is good to have your views. You are, of course, entirely able to use the medical system that you believe is best - and I wish you well. I won't go into the dangers of conventional medicine here, for two reasons. First, my views about the unacceptable dangers of pharmaceutical drugs will not convince you, or indeed anyone else with such closed minds to the benefits of traditional therapies such as homeopathy. Second, patient choice is about just that - what patients want to choose for themselves. So stay clear of homeopathy, and if you want to call it quackery, that's fine. But one question. Why do you want to stop me having homeopathic treatment on the NHS? What right to you have to say that after paying my taxes, and contributing to the NHS, that YOU should have the right to deny me (and thousands of other people) the right to the treatment of my choice? Who has given you this right?

Since World War II a system of medical ethics has been established, with informed consent at its core. Patients should be treated by agreement, and they should know the benefits and harms of that treatment. If this is properly practised, a doctor prescribing homeopathy or anything else should be open with the patient about these factors. The homeopath should explain that there is no solid evidence for it - but does anyone do that? It would be the truth. Choice is fine as long as it's informed choice, but patients are being lied to about homeopathy. It's not acceptable to say that the cost is small and doesn't matter. That really isn't the point. Evidence based medicine is the greatest scientific advance of the last 50 years, in terms of positive impact on society, and allowing evidence-free treatment undermines that. We are in danger of building an `anything goes' culture which will damage public health. Money is already wasted on many other treatments that have inadequate evidence - yes, even some that are considered orthodox. We need to winnow these out. Steve Scrutton misunderstands what evidence is. It is not the opinion of experts, it is what the science tells us. It is very well documented that the higher the quality of a clinical trial, the smaller the observed effect of homeopathy. Not an opinion, a fact. Homeopaths tell us that water has a memory. That is not a fact, because it has not been demonstrated reliably. So who has the vested interest here? Clinical science consultant, Salisbury - Fellow of the Institute of Clinical Research - Fellow of the Society of Biology

Steve Scrutton, Registrar for the Alliance of Registered Homeopaths, would appear to believe that patient choice trumps all. However, as with all 'good things' in life, choice has limits. My choice for having a cold is two weeks in the South of France. It works wonders for me. Are you going to deny me my experience and choice? I presume Steve would see the absurdity in such a position. The NHS was founded on the principle of meeting the needs of everyone - not the wants or the 'choices' - and that services should be delivered on the basis of clinical need - not wishful thinking. Homeopathy does not meet the requirements of public funding because it cannot demonstrate any clinical benefit. It is a pseudomedicine based on absurd premises and practised by deluded individuals. Time to let it go.

Patients often suggest I must believe in homeopathy and look surprised and unsure when I tell them I do not, inasmuch as I do not believe in antibiotics or statins, yet they work and are useful. There are many factors which go into a healing experience and if a mother insists on antibiotics for her child I will prescribe them, against the evidence and guidelines, advising her there is unlikely to be a tangible effect from the prescription, because I know amoxicillin is a safe placebo and the mother's relief to be doing something will impart a sense of reassurance to her treasured child (who is offered a lovely sweet banana flavoured goo by the one they trust the most). Who am I to wrestle away this wonderful opportunity for healing by dogmatically refusing a prescription? Sure there are patients who decline a homeopathic prescription alongside conventional management and similarly there are those disappointed by being diverted to blood tests and hospital investigations when all they wanted was some homeopathy - c'est la vie - they get over these experiences and hopefully experience safe integrated NHS medical care and get better. The old adage goes: 'A doctor entertains their patient whilst nature cures the disease'. Let's entertain with compassion and in safety!!

PS I regularly refer patients for autogenic training on the NHS. Professor Ernst is a patron of the Autogenic Training Association.

Here is a question: Should we should turn the spotlight of EBM on ALL medical interventions on the NHS that don't are not backed by solid evidence or only on homeopathy CAM products? If we didn't use EBM only to attempt to discredit and disallow homeopathy and CAM on the NHS, we would find huge swathes of orthodox medicine failing the EBM test. A pie chart published by the BMJ's Clinical Evidence shows only 12% of common orthodox interventions are backed by solid evidence. Either use EBM as the gold standard or not at all. The way it's being used as a blunt instrument to attack homeopathy at the moment shows the essaying of monsrously bigoted double standards.

I can't let Brian Kaplan get away with this. The figures on BMJ Clinical Evidence need explanation. For a start, numbers of treatments do not reflect the proportion of clinical practice. A treatment gets counted even if it is almost never used - most likely because it's useless. Then don't forget that the treatments counted include complementary and alternative ones, not just orthodox ones. Homeopathy is in there with everything else. But Clinical Evidence doesn't even specify the criteria by which treatments were included, to arrive at the figure of 46% of `unknown effectiveness'. `Unknown' could simply mean not tested. Put simply, this analysis is not at all robust without proper explanation, and as far as I know it hasn't been subjected to peer review. So let Brian Kaplan name a single properly documented case where homeopathy has made a significant impact on public health - and I don't want to hear about the flu epidemic of 1918, that story was blown apart a long time ago. Then let him reflect on how we made smallpox extinct, and why we no longer see polio victims walking with leg irons.

How inconvenient for the 'official deniers' that homeopathy has a 200+ year history of cures written up by qualified doctors and therapists, and that there are the official records of deaths avoided in epidemics by choosing homeopathic treatment over ConMed. How inconvenient also that the Cuban medical authorities reported that homeopathics are now solving their annual leptospirosis epidemic at a fraction of the cost of the previously ineffective ConMed treatment. These are the sort of solid facts the official deniers avoid, because their agenda is to withhold from patients their entitlement under the founding charter of the NHS to opt for effective homeopathic treatment with no side effects. Remember Dec 2003 Glaxo VP genetics Dr Roses: 'The vast majority of drugs - more than 90 per cent - only work in 30 or 50 per cent of the people'. Money wasted? And the cost of dealing with the sometimes horrendous pathology from their side effects. More wasted money not to mention the human suffering. Compare the findings of the Lewisham Hospital NHS Trust Complementary Health Centre Project & the Liverpool Centre for Health survey (http://www.internethealthlibrary.com/Surveys/surveys-UK-alternative-medicine-2.htm#1%20in%205%20using%20complementary%20therapies - In 65% of patient cases, GPs documented a health improvement, with a high degree of correlation between GP and patient assessment of health improvement (source, project monitoring data); - In 65% of patient cases, GPs said they had seen the patient less often following the patient's referral to CAM (source, project monitoring data); after only three months, the GPs acknowledged that the majority of the patients could have reduced drug regimes, particularly analgesics, non-steroidal anti-inflammatories (NSAIDs) and antidepressants. Furthermore, more than half of the patients referred to the centre would otherwise have been referred to a hospital out-patient unit and so there were substantial cost savings. And Patient Satisfaction figures? In the Northern Ireland CAM Project 2008 there was 'found a significant level of health gain for the vast majority of patients who have received complementary and alternative medicine as part of the pilot project' (81% of patients said that their general health had improved, with a similarly high proportion of patients (82%) reporting to be less worried about their symptoms following treatment. And 44% reported having been able to reduce their use of medication) (http://www.dhsspsni.gov.uk/final_report_from_smr_on_the_cam_pilot_project_-_may_2008.pdf). So clearly many patients want and would benefit from CAM, and it is high time that the blocks to their being given it are removed.

Brian Kaplan - yes, of course there should be a spotlight on all therapies to ensure they are backed up with good evidence. But homeopathy is without doubt the pons asinorum - the bridge asses we have to cross. If the NHS struggles to exclude obvious witchcraft then what hope for the far more subtle problems posed by other therapies, often defended by the vast interests of the pharmaceutical business?

There was a framed quotation on the wall in President John F Kennedy's study, 'always try to put yourself in your opponent's place, avoid self righteousness like the devil'. Perhaps it helped him keep calm during the Cuban missile crisis. We lesser mortals also need reminding of the perils of hubris. Medical homeopaths can put ourselves in the position of our critics. Most of us were initially very sceptical, disbelieving, of the homeopathic approach. That gave way to frequent amazement, and acceptance, as we found that individualised remedies did work. Not always. But we did no harm, in pleasant contrast to experience with conventional medication. Where we differed from our critics is that our initial position of scepticism and disbelief led us to more carefully examine the case for homeopathy. We chose not to rush into print with the sort of dismissive comments that may say as much about the writer's state of mind, as about homeopathy. Those 'academics and top NHS managers' who regard moves to extend homeopathic services as 'ill conceived' may be very knowledgeable, but they possibly know about as much of homeopathic method as they know of the other side of the moon. In their excellent preoccupation with EBM and imminent budget cuts, they may not be aware of the points made by Brian Kaplan. Nor may they have time to read widely of our noble profession, particularly an article by Marcia Angell in the New York Review of Books Jan 15th, 2009. She wrote, 'It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgement of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of |Medicine.' A remarkable conclusion, that has gone largely unremarked in the medical press. Surprised ? It is sad that current debate about medical homeopathy is so polarised, often ill tempered. Is it unreasonable to hope that our critics might become more familiar with homeopathy before ridiculing it ? Your own headline , above, illustrates the problem. You chose to include 'ill conceived', in inverted commas. Perhaps the word *experts* deserves similar treatment in the headline ?

@Noel Thomas: excellent points @Les Rose: wrt the BMJ's Clinical Evidence http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp you say 'A treatment gets counted even if it is almost never used' Please explain to me why the authors clearly state: 'So what can Clinical Evidence tell us about the state of our current knowledge? What proportion of commonly used treatments are supported by good evidence, what proportion should not be used or used only with caution, and how big are the gaps in our knowledge?' Notice the phrase COMMONLY USED? And you say you can't let me 'get away with it'!

Be carful what you say - water has memory you know! I tuned in to the Parliament chanel on TV and stumbled on this debate - what a load of old TOSH! Of course there are unproven / non-evidenced based therapies available on the NHS. However this is not an argument for having more - rather the opposite!

Brian Kaplan, if you wish to know how much of medical practice is evidence-based, this may help you: http://www.shef.ac.uk/scharr/ir/percent.html