The Government should hold a public consultation in order to decide whether to provide homeopathy on the NHS, says Dr Andrew Sikorski
It is a fact that many global and particularly European countries’ healthcare professionals use homeopathy and other complementary and alternative medicines (CAM).1
In the UK there is a well-organised dogmatic campaign to remove homeopathy and CAM from the NHS to the detriment of patients’ and practitioners’ health and wellbeing.
Homeopathy is frequently prescribed by doctors in France and Germany. In Italy 45% of medical doctors integrate this system into everyday practice. 2 In Sweden, the Supreme Administrative Court has recently ruled that Swedish doctors can openly recommend homeopathy to their patients. In 2009 a Swiss national referendum voted in favour of complementary medicine being part of the public health service which is now covered by the obligatory public health insurance system. This decision was partly informed by the findings of the 2006 Health Technology Assessment report commissioned by the Swiss Government on the effectiveness, safety and cost-effectiveness of homeopathy in general practice. 3
This report states: ‘In conclusion we have established that there is sufficient supporting evidence for the pre-clinical (experimental) as well as clinical effects of homeopathy, and that in absolute terms, as well as when compared to conventional therapies, it offers a safe and cost-effective treatment.’
Compared to conventional medicine, there is a lack of a level playing field when it comes to considerations of evidence surrounding homeopathy/CAM e.g. the fact that there is no scientific evidence for >50% of 3,000 conventional medical procedures in the NHS 4 and that SSRI drugs, no better than placebo in mild and moderate depression 5, can still manage to earn profits in the order of many billions of dollars. Meanwhile homeopathy is accused of being ‘merely’ a placebo and campaigns are mounted for its eradication from the NHS to save no more than £4 million.
Opponents of CAM might see democratic, governmental decisions based on the assessment of the available scientific evidence as an example of weak legislators pandering to public opinion. A similar, well-informed, public consultation would be welcomed in the staunchly democratic UK. This would be in line with Government policy which encourages greater patient choice by putting the patient at the centre of healthcare provision.
Well-informed patients are quite capable, when presented with the arguments, of making an intelligent decision on what they wish for their health service to provide – the basis of informed consent, which includes the right to withhold consent.
People have long been in favour of homeopathy and CAM because they have used it and found it to work and satisfy their needs. The level of patient satisfaction at NHS homeopathic hospitals is consistently high. In an extensive six year study at the NHS Bristol Homeopathic Hospital found 71% of 6,544 follow-up patients, previously conventionally treated for a wide range of chronic medical complaints, reported positive health changes. 6
Critics of homeopathy greet research evidence, patient reported outcomes measures and governmental decisions with disdain adopting a false intellectually superior manner to explain away the improvement in patients’ health by placebo or natural ‘regression to health’ and ignoring any effects from the homeopathic intervention.
With particular regard to evidence: Sir Michael Rawlins, chair of NICE stated: ‘RCTs, long regarded as the “gold standard” of evidence, have been put on an undeserved pedestal.’
‘Their appearance at the top of hierarchies of evidence is inappropriate, and hierarchies are illusory tools for assessing evidence. They should be replaced by a diversity of approaches that involve analysing the totality of the evidence base.’ 7
David Sackett said: ‘Evidence-based medicine is not restricted to RCTs and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions… If no RCT has been carried out for our patient’s predicament, we follow the trail to the next best external evidence and work from there’. 8
Of the 18,000 RCTs of conventional medicine performed every year, the Duke Centre for Evidence-Based Practice in the US comments: ‘Because of the paucity of high quality evidence, the data available – though voluminous – may have little meaning or value for informing clinical practice.’ 9 There is also the recent exposure of large-scale systematic abuse, cheating and plagiarism perpetrated during industrially-financed drug research. 10, 11
CAM in general and homeopathy in particular, appear to be disingenuously judged for supposedly not conforming to a set of limited evidence criteria which themselves are very much being questioned from within conventional medicine.
There are many RCTs that do in fact confirm what half a billion people world-wide already know, amongst them many scientists and clinicians: Homeopathy isan effective therapeutic modality and being cheap should be more widely investigated and implemented alongside conventional medicine particularly in the current financial climate.
Dr Andrew Sikorski is a GP in Wadhurst, East Sussex
1. Brinkhaus B, Witt CM, Jena S, Bockelbrink A, Ortiz M, Willich SN. Integration of complementary and alternative medicine into medical schools in Austria, Germany and Switzerland – results of a cross-sectional study. Wien Med Wschr 2011; 161(1): 32-43
2. Sarsina PR, Iseppato 2011: Looking For A Person-Centred Medicine: Non- Conventional Medicine in the Conventional European and Italian Setting; Evid.Based. Complementary and Alternative Medicine 2011; 382-961. Published online 2010 Dec. 27.doi:10.1093/ecam/rep048
3. Gudrun Bornhöft and Peter F. Matthiessen 2006: Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs. Published by Springer 2011
5. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al. (2008) Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Med 5(2): e45. doi:10.1371/journal.pmed.0050045
6. Spence D, Thompson E, Barron S. Homeopathic treatment for chronic disease: a 6-year university hospital based outpatient observational study. J Altern Complement Med 2005; 5: 793–8.
7. Rawlins M. De Testimonio: On the evidence for decisions about the use of therapeutic interventions. The Harveian Oration. Delivered to the Royal College of Physicians, London, October 16, 2008. Online document at: www.rcplondon.ac.uk-news-news.asp?PR_id¼422
8. Sackett, D.L. et al. (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312 (7023), Jan, 71-72.
9. Abernathy A. Draft systematic review of off-label use of oncology drugs. Duke EPC 07/11/2009 10. Titus SL et al., Nature 453, 980–982 (Jun 2008).
11. Fanelli D. How Many Scientists Fabricate and Falsify Research? A Systematic Review and Meta- Analysis of Survey Data. PLoS ONE 2009; 4(5): e5738