What place for homeopathy?

Offering homeopathy “on the NHS” is a highly contentious issue among medical professionals today

HOMEOPATHY sounds harmless. Its very nature is based on treatments that are highly diluted and non-toxic versions of an original substance.

But what is a benign and popular range of treatments for some people has recently provoked a perhaps surprisingly strong and angry reaction from parts of the medical profession.

Some doctors want an end to any NHS funding for such treatments and to stop pharmacists from labeling homeopathic products as ‘medicines’.

A storm erupted at this year’s BMA annual conference in June where during one of the longest and most animated debates, delegates voted overwhelmingly for an anti-homeopathy motion.

Prior to the debate, supporters of homeopathy gathered in front of the conference venue in Brighton with banners and placards to let doctors entering the building know their views and urge them not to vote for the motion.

Despite this, three quarters of the doctors there agreed that in the absence of valid scientific evidence of benefit, there should be no further commissioning of, nor funding for, homeopathic remedies or hospitals in the NHS.

Even more (82 per cent) voted in another part of the motion that no UK training post should include a placement in homeopathy, and 63 per cent agreed that pharmacists should remove homeopathic remedies from shelves if they are presented as ‘medicines’ and only sell them if clearly labelled as ‘placebos’.

Homeopaths were surprised at the degree of animosity voiced at the conference about the treatments and are now worried that the next generation of doctors is becoming more conservative and intransigent.

Effective treatment or placebo?

Homeopathy – a system of healing which claims to help the natural tendency of the body to heal itself – was first proposed in 1796 by German doctor Samuel Hahnemann.

Some forms of complementary medicine including homeopathy have been integrated with the NHS ever since it started in 1948 and there are four NHS homeopathic hospitals in Bristol, Glasgow, Liverpool and London, which treat 55,000 patients a year collectively.

More than 400 GPs in the UK practise homeopathy, treating around 200,000 NHS patients per year this way. The NHS spends approximately £4 million a year on homeopathy for treatments and funding of the homeopathic hospitals – around 0.001 per cent of the £11 billion drugs budget.

Despite its firm footing in the NHS, homeopathy has prompted strong criticism for receiving NHS funding, initially emerging at the BMA’s junior doctors’ conference in May and then again at the full BMA annual conference in June.

One of the most notable and outspoken critics addressing the conference was Dr Tom Dolphin, vice chair of the BMA’s junior doctors’ committee.

Dr Dolphin says: “I don’t have a huge problem with the use of placebos as they clearly do have benefits for patients. The problem I have with homeopathy is that it is dressing up placebo with pseudo-science, which if you look at it, is farcical. My opinion of homeopathy is that it is nonsense and has no basis in clinical reality.

“Because of that, patients are being misled into thinking there’s more to it than there is. In over 100 clinical trials, it’s never been shown to be any better than placebo.”

He accepts that the £4million being spent by the NHS on homeopathy is not a huge amount from the NHS’s overall budget, but adds: “It is a waste of NHS resources and having it supported by the government gives it an undue legitimacy. I’d like to think in an era of austerity that things that have shown in many clinical trials to have no benefit would be stopped.”

Dr Mary McCarthy, a GP from Shropshire, who proposed the motion said at the conference: “Homeopathy can do harm – it can divert people from conventional medicine.

“We are not asking for homeopathy to be stopped. What we are asking is that it’s not funded by scarce NHS resources.”

Why ban something that works?

However, other doctors at the conference spoke in favour of homeopathy, such as Dr John Garner, a GP from Edinburgh, who said: “Some patients find benefit and relief in homeopathic treatments be it placebo effect or not.

“We have a duty to support patients if something works for them. This [ban] would deprive patients who have found benefit from homeopathic remedies in their current treatments. ”

Organisations like the British Homeopathic Association and the Faculty of Homeopathy, which represents doctors who practise homeopathy, were also not impressed with some of the comments made during the BMA debate.

Dr Graham Jagger, a GP and NHS primary care representative on the board of the Faculty, says: “To stop NHS funding for homeopathy is not going to save very much money at all.”

Dr Jagger feels the BMA debate reflects a shift in attitudes. He says: “We’ve been going through a change of junior doctors’ training that has unsettled the whole medical profession quite radically.

“The doctors are becoming a lot more conservative and more reactionary. It’s almost like a dark ages that we are going into. Doctors now have to look as if they’ve got their roots firmly on the ground and can’t look as if they are free thinkers or lateral thinkers.”

Dr Jagger says he has never been keen on placebos, but adds: “There is a placebo effect in everything. I don’t switch on my placebo hat just when I do prescribing for homeopathy.

“Most of what I am doing might have some placebo effect; if I prescribe an aspirin, it will have a placebo effect as much as if I prescribed a homeopathic tablet. But I wouldn’t prescribe placebo as a treatment.”

Dr Jagger says he tends to recommend homeopathic treatment to patients instead of conventional medicine in about 10 per cent of cases. In situations where a patient chooses a homeopathic treatment rather than conventional medicine, he believes there does not need to be an ethical dilemma for doctors.

“There needn’t be a dilemma as long as we are treating something that we feel is going to respond and is not dangerous to do,” he says.

“If someone came in with malaria, for example, and said they’d rather have homeopathy, I’d say no. We know that there are conventional treatments that work very well and we know there are homeopathic treatments that might not work at all. I would want to try the best for the patient.”

Asked why he thinks there is real antipathy to homeopathy in some parts of the medical profession, he says: “I think it’s because there isn’t a scientific basis to the theory of why it works. In 100 or 200 years time, we will discover why it works but at the moment we don’t know why.”

Dr Jagger believes more should be spent by the NHS on homeopathy and argues that the homeopathic hospitals have an important part to play.

“These hospitals do an enormous amount of good work that would be far more expensively addressed elsewhere. Homeopathy is a very useful adjunct to what we’ve got and we would be lost without it.”

Political argument

Opposition to homeopathy also emerged earlier this year when MPs on the House of Commons’ Science and Technology Select Committee published a report of their inquiry into homeopathy1 in February, calling for a ban on NHS funding. MPs on the committee urged the government to withdraw NHS funding for such treatments and for the medicines regulator to stop licensing homeopathic products. For doctors to prescribe a homeopathic treatment was damaging the integrity of the doctor-patient relationship, said the committee.

Despite this, in July, the Department of Health published its official response2 to the report and rejected the MPs call, saying it supported NHS funding for homeopathy. The Department said the use of homeopathy on the NHS did not amount to a “risk to patient trust, choice or safety”.

Public health minister, Anne Milton said: “We believe in patients being able to make informed choices about their treatment, and in a clinician being able to prescribe the treatment they feel most appropriate in particular circumstances, which includes complementary or alternative treatments such as homeopathy.”

Homeopathy, it seems, has for now won the argument to stay.

Adrian O’Dowd is a freelance medical journalist

WEB LINKS

1 http://tinyurl.com/329mk2e
2 http://tinyurl.com/2vmv6pt