Dr Susan McAllion makes the case for homeopathy in the NHS

Scotland has a long and happy association with homeopathy. In 1880 a dispensary was opened which gave free treatment to the poor. The first homeopathic hospital in Glasgow opened in 1914 and after several moves it is now located on the Gartnavel site.

There are also homeopathic hospitals in London and Bristol and all three hospitals have been part of the NHS since it began in 1948.The hospitals and NHS clinics (of which there are several in Scotland) treat tens of thousands of patients per year who are referred by GPs, PCTs and NHS specialists.

Four of five major comprehensive reviews of RCTs in homeopathy have reached broadly positive conclusions.1-4 Based on a smaller selection of trials, a fifth review came to a negative conclusion about homeopathy.5 In 2005, the Bristol Homeopathic Hospital carried out the largest service evaluation of homeopathic treatment so far, which reported that 70% of 6,500 follow-up patients experienced improvement in their health. Many had tried conventional treatment first without success.

The most recent hospitals outcome study confirms the positive findings of earlier studies. A total of 1,602 patients were seen at follow-up appointments in UK NHS homeopathic hospitals during one month in 2007. The study found that eczema is currently the most common referral to homeopathy by NHS doctors. Other commonly treated complaints were chronic fatigue, menopausal disorder and osteoarthritis.

In the UK there are over 400 GPs practising homeopathy who are regulated by the GMC and are members of the Faculty of Homeopathy. They treat around 200,000 NHS patients per year with homeopathy. Homeopathic medicines are very safe .The vast majority of adverse effects reported in clinical trials were temporary aggravations of symptoms or other mild and transient effects. Homeopathic remedies are cheap. The available evidence suggests that homeopathy has the potential to generate savings through reduced conventional prescribing and demand for other services.

In France, where homeopathy is an integral part of the healthcare system, a government report showed that the total cost of care per patient receiving homeopathic treatment was 15% less than the cost of treatment provided by conventional physicians.

Homeopathy doesn’t interfere with conventional medicine and should be seen as a complementary treatment, not as an alternative. In fact, homeopathic and conventional treatments can work very well alongside each other. This approach also gives patients more treatment choices. NHS homeopathic doctors are medically trained as well as being members of the Faculty of Homeopathy. They are statutorily registered with the General Medical Council . They are bound to act within the competence of their profession and their level of training and qualifications in homeopathy.

Homeopathy has been under attack from a small number of scientists and science journalists. Unfortunately this has resulted in a polarisation of views on the subject.

One criticism is that the effect of high dilutions is implausible with no basis in real science. There is an increasing amount of laboratory research that is extending our understanding of how such dilutions work and scientists have admitted surprise at their own findings. To summarise, homeopathy is a safe, cost effective complementary therapy which should be available to all in the NHS.

Dr Susan McAllion is a retired NHS homeopathic doctor and a past Treasurer of SHA Scotland.

References

1. Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homeopathy. Br Med J 1991; 302: 316–23.
2. Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834–43.
3. Linde K, Scholz M, Ramirez G, et al. Impact of study quality on outcome in placebo controlled trials of homeopathy. J Clin Epidemiol 1999; 52: 631–6.
4. Cucherat M, Haugh MC, Gooch M, Boissel JP. Evidence of clinical efficacy of homeopathy – A meta-analysis of clinical trials. Eur J Clin Pharmacol 2000; 56: 27–33.
5. Shang A, Huwiler-Muntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy.
Lancet 2005; 366: 726–32.

From Healthier Scotland: the Journal

SHA and homeopathy

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9 Comments

  1. What Dr. Susan McAllion says is correct and if you agree, please sign the Petition to Save the Glasgow Homeopathic Hospital. In fact, many people don’t realise that there were once 14 homeopathic hospitals in the UK and if we lose this excellent hospital, Bristol may not be far behind.
    https://www.change.org/en-GB/petitions/nhs-greater-glasgow-and-clyde-save-the-glasgow-homeopathic-hospital

    1. Guy Chapman says:

      No it’s not correct. As Alan Henness points out, it is wrong in every important respect.

  2. Guy Chapman says:

    Here is a list of all the scientific evidence supporting the principles of homeopathy:

    That didn’t take long.

    Homeopathy is founded on the idea that like cures like (it doesn’t), that dilution increases potency (it doesn’t), that disease is caused by miasms (they don’t exist) which disturb the body’s vital force (it doesn’t exist). No part of the supposed theories and principles of homeopathy is supported by any evidence at all.

    As if that was not bad enough, it violates the laws of thermodynamics and conservaiton of energy, is contradicted by everything we know about the nature of matter, is inconsistent with chemistry, biochemistry and human physiology as we have come to understand them.

    Science has an elaborate system of review and debate that allows it to discard wrong ideas. Homeopathy has one. There is no way of objectively testing anything in homeopathy (as any objective tests show homeopathy itself to be bogus) so no way of settling the long-running disputes over whether “imponderables” like light of venus or mobile phone radiation should be allowed, or whether the Korsakovian method is valid (where all the mixture is poured away and the vessel refilled for each serial dilution, instead of one drop being added to a vessel with 100 times that much water).

    The substances used vary from dog excrement to arsenic to plutonium, so it’s just as well that by the time the homeopaths have finished with them there is nothing left but solvent. This is doubly fortunate since there is no known connection between the “remedies” they prescribe and the actual symptoms they are treating. Sorry, did I say symptoms? I mean of course disease – medicine only treats symptoms (like bacteria, a symptom of…. er… having a bacterial infection) whereas homeopathy treats “the whole person”.

    Starting of course with the wallet, a body part notoriously prone to being overweight, a problem easily treated with homeopathy.

    The only value of homeopathy is as a tool in teaching critical thinking. It is so easily shown to be wrong, that even a child can spot the fallacies. Pity so many adults fail to show the same reasoning abilities.

  3. Alan Henness says:

    It would be worthwhile to quote what the papers McAllion cited actually said, rather than rely on her summary that they ‘reached broadly positive conclusions’:

    1. Kleijnen et al., 1991, meta-analysis, 107 trials. (Source)

    CONCLUSIONS: At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials.

    2. Linde 1997, meta-analysis, 89 trials. (Source)

    The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.

    3 Linde 1999 (Source)

    The evidence of bias [in homeopathic trials] weakens the findings of our original meta-analysis. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality trials… have negative results, and a recent update of our review for the most “original” subtype of homeopathy (classical or individualized homeopathy), seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments.

    4. Cucherat et al. 2000 (Source)

    There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies. Further high quality studies are needed to confirm these results.

    5. Shang et al. (Source)

    Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.

    My emphasis.

    McAllion said:

    In 2005, the Bristol Homeopathic Hospital carried out the largest service evaluation of homeopathic treatment so far, which reported that 70% of 6,500 follow-up patients experienced improvement in their health.

    That was a customer satisfaction survey that did not measure treatment outcomes. It did not show that customers’ perceived improvement was due to any sugar pills they might have taken.

    Most of the rest of her piece are simply fallacious arguments, particularly argumentum ad populum and have no bearing on the lack of any good evidence for homeopathy.

    And finally, a cheap treatment is worthless if it is not also effective – and this is where homeopathy utterly fails, of course.

    1. Alan Henness says:

      Apologies – my emphasis doesn’t show up in the quotes but I think it will be clear enough that those papers do not reach ‘broadly positive conclusions’ for homeopathy.

  4. Valerie Iles says:

    Goodness what a lot of anger here. And what about?
    Treatment that is cheap, harmless, that no-one is forced to undertake, being offered by medical practitioners with an array of conventional treatments also at their disposal.

    Personally I do not use homeopathy because I do not subscribe to the arguments lampooned above by Guy Chapman, but any placebo effect is in itself valuable and trials that talk of ‘little or no greater efficacy than the placebo effect’ suggest to me that as long as it is cheap and an effect not smaller than the placebo effect, then homeopathy has a place in our offerings.

    This feels like an argument between enraged scientists rather than between people working with real patients trying to deal with their problems without causing more harm.

    Homeopathy costs the NHS so little money that closing down these hospitals is equivalent to the argument that because a hostial trust £30 million faces a £X0m deficit no sandwiches will be provided at working lunches.

    Chill everybody!

    1. Alan Henness says:

      Valerie Iles said:

      Goodness what a lot of anger here. And what about?

      Where’s the anger?

      However, that’s a side issue. The real issue is about the good evidence for homeopathy (there isn’t any) and if there isn’t, why you would want to then knowingly give them to patients, telling they will do more than the evidence demonstrates (which is nothing above placebo) – it’s called lying to patients. I don’t think the taxpayer should be paying for people to lie – do you?

      Oh, and how many nurses would that £30 million provide.

    2. Valerie, placebo effects are transient and unpredictable and only really work on subjective symptoms. The problem with homeopathy is that its practitioners do not believe it really is placebo, they subscribe to a religious doctrine that says homeopathy is a powerful form of medicine. This goes against all the evidence. Some alternatives to medicine are plausible to some degree and have an overlap with effective therapies (chiropractic, for example, is manipulative therapy plus woo), homeopathy is only woo. Nothing else.

      The anger only starts when homeopaths start proposing their woo in place of real and necessary medicine. This is, unfortunately, endemic. Sting operations by the BBC found that every single homeopath consulted recommended homeopathy instead of antimalarials to people about to travel to malaria zones. They didn’t even give bite avoidance advice. That is criminally irresponsible, and the society of homeopaths did precisely nothing about it.

      Nor is homeopathy cheap. Referring someone to a homeopath imposes additional cost that could be eliminated entirely by the doctor prescribing a placebo, if only that was agreed to be an ethical practice (and there is a big debate about that). The remedies themselves are vastly overpriced for what they are, OTC prices are comparable to real medicines which have had multi million dollar R&D programmes and undergone extensive (and expensive) clinical trials before they can be marketed.

      I am all for doctors discouraging overmedication, but homeopathy forms no part of that. No ethical doctor could refer a patient to a homeopath knowing that the homeopath will go through some theatre and propose a placebo which they will do their level best to persuade the patient is a powerful remedy. There are two possible outcomes: either it doesn’t work, in which case the money was wasted, or it does work, in which case the patient has been seduced into a false belief in something that has no objectively measurable effect. The latter is really quite dangerous as people may then use it in place of real medicines. There is a reason why SCAM users have worse cancer outcomes than people who don’t use SCAM.

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