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GPs go forth

Are doctors pushing patients into the arms of homeopaths?

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It’s rather astonishing that the NHS does pay for homeopathic treatment in this age of evidence-based medicine, and someone has finally had the courage to point this out to the people who hold the purse strings.

The Good Thinking Society has threatened to take Liverpool CCG to court over their decision to fund £30,000 worth of treatment with NHS funds, and the CCG have so far been forced to review their decision.

NHS homeopathic hospitals have been in decline recently, with the Bristol Homeopathic Hospital scaling back services, and both the London and Glasgow Homeopathic hospitals ditching the ‘homeopathy’ label in favour of less controversial terms – rebranding themselves as the Royal London Hospital for Integrated Medicine and the Glasgow NHS Centre for Integrative Care respectively.

Will this latest development be the final nail in the coffin? I doubt it, but it will be interesting to see how it plays out.

It’s easy to ridicule homeopathy, yet I can see why it caught on when it first came on the scene in 1796. In fact, I’d go as far to say that in the 18th and 19th centuries if you were to see a doctor at all, you would have done well to see a homeopathic one.

At least they used only one medicine at a time, and a harmless one at that, while the orthodox medical intelligentsia would combine aggressive bloodletting with such enthusiastic polypharmacy that the chances are you’d end up with more toxins in your blood stream than red corpuscles before they had finished with you.

What is fascinating is that it was the over-use of harmful medicines that drove Samuel Hahnemann, the founder of homeopathy, to come up with his theories in the first place – ideas that have no scientific credibility in today’s eyes, but were no less crackpot in his day than many of the orthodox beliefs held at the time.

The questions we must ask ourselves are these: are we at risk of making the same mistakes as Hahnemann’s contemporaries?

Are we so over-medicalising and over-treating our patients with the harms they are subjected to from our plethora of pills, that they will flee from orthodox medicine into the welcoming arms of alternative practitioners who will take the time to listen and give them what they want?

Even more importantly, are we willing to subject our own medicine to the same scientific scrutiny that we expect homeopathy to stand up to?

Or will we continue to practice medicine which we might believe in as much as the homeopaths do, but which is equally thin on actual evidence that it works?

Put me in charge for a day and I’d throw out a number of things we do - health checks, statins in the elderly, tight glycaemic control in Type II Diabetes and treatment of mild hypertension would all be scrapped by lunchtime.

No-one is going to put me in charge, of course, but maybe someone would like to threaten to sue NHS England for the waste of tax-payers’ money on their health checks programme? Now that really would be a development.

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.

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Readers' comments (70)

  • At last a common sense intervention on the issue of homeopathy in the NHS. The febrlle atmosphere created by Simon Singh and his so-called 'Good Thinking Society' is equivalent to a form of extreme 'cleansing', with representatives of a dominant culture attempting to oust any view, practice or interest that threatens its dominance and economic interests.

    The evidence base for much of what is practised in the NHS is very poor with only 11% having any robust basis
    Furthermore much of the evidence that does exist has been revealed to be biased
    As Martin Brunet writes: "Even more importantly, are we willing to subject our own medicine to the same scientific scrutiny that we expect homeopathy to stand up to?

    Or will we continue to practice medicine which we might believe in as much as the homeopaths do, but which is equally thin on actual evidence that it works?

    Homeopathy is mostly used within the NHS for patients for whom conventional approaches have not worked. Singh and his group are ultmately attacking therapeutic plurality and patient choice while protecting options that are not just weak in evidence but potentially dangerous and a huge waste of taxpayers' money.
    I propose puting Martin Brunet in charge of the NHS for a day - he'd save more in a minute than the petty amount Simon Singh is on about.

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  • The Faculty of Homeopathy has been training doctors in Homeopathic medicine since the NHS was established- and has a responsible officer for revalidation purposes.
    Homeopathy works and is a useful and fruitful adjunct to the clinical toolbox which my patients and I have found helpful in NHS General Practice.

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  • Catch a grip. It works via placebo / nocebo balance. Expensive water with the 'therapy' in the play and drama and therapeutic atmosphere in whic it is delivered . We're not politicians - can we at least be honest.

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  • It depends on the type of practitioner you are.
    Is paracetamol not a huge waste of taxpayers money, alongside the majority of glitzy emollients and topical NSAID gels?

    The value of medicinal products and the history of medicine is sadly taken for granted in the 21st century...if an agent does not work after 3 days it is an awful choice of therapy to some patients.

    Homeopathy I would advocate - why not: a lot of other chemical based agents have little to go on but are now the fabric of generic prescribing serving to solve the non-severe symptom and not the causative problem. Prescribing yoga, exercise, hydration and sunshine therapy for most minor ailments will never be nationally supported due to the NHS supply chain requirements and so the mind body axis will be knocked about for some time to come.

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    “likes are cured by likes”] the doctrine, which lies at the foundation of homeopathy, that a disease is cured by those remedies which produce effects resembling the disease itself.
    DIgoxin & Ritalin are excellent examples of homeopathic medicines in regular daily use.
    Please think about it?

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  • homeopathy is by definition, water. If it contains anything other than water then by definition it is not homeopathy.
    Claiming that water is a cure for anything other than dehydration is, in my book, an act of criminal fraud and it should not be anywhere near the NHS

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  • Homeopathic medicine is much, much, much more than water and perpetuating the bigoted myth it is just 'water' is the criminal fraud.

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  • I do not think Martin Brunet endorses Homeopathy, he simply points out that a lot of the conventional medicine we practise could do with more critical appraisal.
    Bring back Edzard Ernst

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  • The question raised about doctors over-treating patients with treatments that may be useless and even harmful is a very pertinent one but homeopaths are far from innocent in this respect. As the most extensive investigation into homeopathy ever carried out found no good evidence that homeopathic products are effective for any condition, it's surely safe to conclude that the sole benefit of homeopathic consultations to patients are that practitioners will indeed "take the time to listen and give them what they want". But what is it that they want? The answer seems to be a prescription of something or other and if it's accompanied by a narrative that it's a "natural product that will stimulate the body to heal itself" or words to that effect, so much the better.

    Homeopaths promote their products ad nauseum in their advertising materials, websites and on social media. Look at #homeopathy on Twitter and you will see them claiming they have remedies to cure everything from anxiety to autism to infertility to cancer. Does anyone ever get away from a homeopath without a prescription for some expensive sugar pills? It seems to me they seek to medicalise every conceivable problem under the sun and do more than any doctor to ensure a culture of dependency on pills and practitioners - and that is a fundamental problem that needs addressing in all healthcare practice.

    The other problem, of course, is how to give so many patients the real benefits of homeopathy and other alternative treatments i.e. time and the patience to listen to and empathise with them in a cash-strapped, over-burdened publicly funded health service.

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  • ... or we could have an evidence based discussion?
    There have been a number of valid metanalyses of homeopathy which have either found an effect beyond placebo or were equivocal. The most recent - the first of homeopathy as actually practiced in a service like the one in Liverpool - cautiously concludes the treatment may be better than placebo.
    Mathie, Robert T., Suzanne M. Lloyd, Lynn A. Legg, Jürgen Clausen, Sian Moss, Jonathan RT Davidson, and others, ‘Randomised Placebo-Controlled Trials of Individualised Homeopathic Treatment: Systematic Review and Meta-Analysis’, Systematic Reviews, 3 (2014), 142
    The much trumpeted Shang et al paper which has formed the basis of the 10 year campaign against homeopathy didn't actually conform to basic standards of meta-analysis. Bit embarrassing really if you think about it

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