Wrong to let patients use budgets for treatments like homeopathy, says BMA

Yes I agree. Just because 'choice' is nominally a good thing, this does not mean that patients or the lay public in general are intelligent or medically educated enough to choose the sort of healthcare they think they need. The BMJ is correct in saying that they should certainly not be able to 'choose' unproven treatment. This clearly includes the majority of conventional treatments. This is well illustrated in this pie chart published by their own journal, the British Medical Journal (BMJ), which shows that only 12% of conventional interventions are fully supported by 'evidence'. http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

Wearily, I have to correct Kaplan's misinterpretation of the Clinical Evidence pie chart. The arithmetic really is very simple. It is a display of numbers of treatments, not proportions of clinical practice. For a start, the database includes all treatments, including complementary and alternative. It is counting all those things which most doctors would not use simply because they are known not to work. But they get counted anyway. Far more authoritative publications estimate the proportion of clinical practice at up to 80%. Not good enough, but better than any CAM practitioner. In any case, when was `tu quoque' ever a valid argument?

Patient choice will prove to be a bonus for GPs, adding many new options to their list of treatments available to patients. No longer the pressure, from many patients, to prescribe drugs that either don't work, or are dangerous, but a choice of medical therapies. Gone are the days when the BMA, or anyone else for that matter, can dictate to people what treatment they should receive. Some people will demand treatments they want, not treatments imposed on them. Others will be much happier being given a choice. The cost of most alternative therapies, such as homeopathy, is much less than the conventional equivalent. Dr Meldrum wants patients to have choice, but only for treatments he wants them to have. That is just not choice!

Doctor knows best then eh? Yet every time patients are asked their views on their homeopathic treatmens they report high levels of satisfaction.

I have no objection to a patient uing their share of the budget on what ever treatement they like, proven or not, mainline or complementary. I do not mind. However if they run out of money/budget in December they will have to go without treatement until April! Will any politician be brave enough to do this?

Well how about this? Medical students want conventional medicine to include alternative therapies - 26th January- http://bit.ly/bZIITg

With all the truths coming out about the danger and misuse of conventional treatment, I would hardly call patients having to choose treatments medically uneducated or unintelligent. And I would heartily disagree that it is wrong to allow patients to pursue the healthcare that they believe is better for them. The 'evidence based' requirements are getting a bit 'old fashioned' in this day and age. There is a lot more to healing than using only 'evidence based treatment', which is only the result of expensive trials that too often show conflicting results.

From the JRSM :J R Soc Med 2010: 103: p34-36 '(Tessier's homeopathic) ward had a higher throughput, and lower mortality... with medical supplies costing only 1% of those used by allopaths.' Not very interesting in these times of spending restraint? Not worth further investigation? Don't bother reading it!

Alas, I too, wearingly and repetitively have to correct Rose's and others' misinterpretation of the Clinical Evidence pie chart which you can see here: (as well as the text from which I will now quote) http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp Rose says: it refers to 'things which most doctors would not use' BMJ says: 'commonly used treatments' So I should assume that this means commonly used by patients but not commonly prescribed by doctors? I don't think so. Rose says:'the database includes all treatments, including complementary and alternative.' Really? Where is your source for this? Does it include 'healing'? Does it include Reiki? Witchdoctor remedies? Trepanning?? Where is the boundary between what it includes and what it does not? And how Rose knows what it includes and what it does not, only he can explain. Perhaps people like Rose, Ernst, Coquhoun, Baum etc. should launch a campaign similarly vicious and jeering to the one they have launched against homeopathy, against the BMJ for producing such an apparently low-quality, misleading, dangerously misinterpretable pie chart that only super-intelligent and highly informed medically trained people (and clearly a doctor such as myself hasn't got a clue how to read it) can fully understand. According to Rose, it does NOT actually show that HUGE SWATHES of orthodox interventions actually have insufficient evidence behind them - but you have to know how to read behind the chart to see this ;-)

@Les Rose: Sorry I didn't respond to your 'tu quoque' description of my position here. Perhaps it's unfair of me to say that doctors in glass houses shouldn't throw stones? Just because many multi-million dollar 'breakthroughs' in medicine (see the huge report on anti-depressants here http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045 for some seriously depressing reading) absolutely lack evidence for the way they are being commonly used by medical doctors, doesn't mean that anti-CAM campaigners like yourself shouldn't continue to use Evidence Based Medicine as a blunt instrument EXCLUSIVELY to attack homeopathy, CAM and any other interventions you are personally against. After all it's the end the justifies the means, isn't it? And clearly it is the detractors (and not the practitioners) of homeopathy and CAM who altruistically have the benefit of humanity as their ultimate aim.

In our family, we should even be able to get a refund on our health budget quota. My son has not been to the doctor for 20 years, and both his parents can't remember the last time they have been either. The answer to this amazingly healthy family - homeopathy. Not good news for the pharmaceuticals though. Ah, let's not forget the dog with cancer who has successfully been treated with homeopathy, which was paid in full by a well-known supermarket's health dog insurance.

For Brian Kaplan's edification, I am going to cite my colleague Professor John Garrow, who points out that what the BMJ Clinical Evidence chart does not tell us is what proportion of PATIENTS receive a treatment that is 'beneficial'. Unfortunately we are not told how many DISEASES are covered in this survey. If we look up the advice on a given condition (eg. low back pain) there are 18 treatments considered, but probably for other less common diseases there will be fewer treatments considered. Let us be generous and assume that on average there are 10 treatments per disease, then 2,500 treatments are being used for 250 diseases. But we know that there are at least 12% of beneficial treatments, so 12% of 2,500 is 300, so the data are compatible with 100% of patients having at least one effective treatment, with a spare 50 treatments for a second choice. What we need (and should try to collect) is the evidence for the treatments that patients actually receive. Now there has been excessive attention to this BMJ publication (and its editor has not been willing to explain the data any further). The scientific literature contains many other publications which effectively demonstrate that a majority of modern clinical PRACTICE is evidence based. There is an excellent review paper in the journal Complementary Therapies in Medicine (yes, really), that cites 15 studies showing EBM ranging from 55% to 97% across a range of specialisms. You can read the full text here: ttp://www.veterinarywatch.com/CTiM.htm Certainly, orthodox medicine is far from perfect, but Kaplan and his supporters ignore the matter of the ratio between benefit and harm. Citing one drug class where the evidence is a lot weaker than we thought (it is not actually absent) does not mean that all drugs cause more harm than good. Finally, higher authorities than I have concluded that homeopathy does not work, including the head of professional affairs at Boots, the head of the MHRA, the government minister responsible for the Department of Health, and the chief scientist at the same Department. Take it up with them.

@ Les Rose: What a pity the editor of the British Medical Journal will not endorse your interpretation of their pie chart. Why don't you extend your vindictive attack on homeopathy to the BMJ. In your world view, the silence of the BMJ on this matter must be seriously damaging. *** And what on earth do you mean by your concluding 'take it up with them' where 'them' includes the minister of health. May I quote to you the exact words of the Minister of Health, Mike O'Brien to the hearing on NHS homeopathy by the Science and technology Commitee at the House of Commons: ‘We take the view that it is not our job to stop clinicians prescribing these medications if they feel they are appropriate.’ Striking a blow for liberty worthy of John Stuart Mill, the Honorable Minister went on to say that cutting the (NHS) funding would be 'illiberal' and 'a denial of personal choice'. He also said there were a range of opinions amongst clinicians and scientists which could not be ignored. A statement clearly worthy of derision on your part, may I assume. The 20% of GPs who want NHS homeopathy should clearly be bullied (Stalinistically if necessary) into toeing the line. Fortunately our government (as represented by Mike O'Brien) hasn't got that bad - at least not yet. Liberty and democracy and clinical choice is the issue here - as I've always maintained. Doctors need to be respected in the choices they make - while being held accountable for their decisions of course. Those who would legislate otherwise strike at the essence of liberty itself.

I have tried to address Kaplan's remarks in a scholarly and polite manner. It is disappointing to see such an intemperate response published. His selection of O'Brien's evidence to the committee seems typical of the modus operandi of the CAM fraternity. Of course the minister did say that. Facts are facts, but he also said publicly that homeopathy does not work any better than placebo. Whether we consider it morally defensible for him to admit that, and then to offload the responsibility to others, is open to debate. O'Brien's reliance on `a range of opinions' exposes his misunderstanding of science. Opinions are not the same as evidence. By the way, I was not talking about the editor of the BMJ, but about its Clinical Evidence publication. They are separate.