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    Dr Alex McMahon argues homeopathy is flying in the face of science, spending precious resources, undermining the principles of the NHS, and doing more harm than good to those most in need.

    Samuel Hahnemann, who invented homeopathy, probably meant well when he devised his idea for the ailments of humanity at the end of the 18th century. Most people have heard of the ‘like cures like’ idea, and may be sympathetic. Most people probably know that homeopaths dilute their treatments to such a degree that there is not a single molecule of the original material left: and then turned into pills. This is not ‘like cures like’. Hahnemann himself, if he was here to defend himself, may well argue that he was trying to be scientific and improve on dreadful treatments like bloodletting and purging that were common in his day. At the turn of the 19th century it may well have been a dangerous gamble to visit a physician: cure or kill.

    Unfortunately Hahnemann extrapolated his theory from a single experiment. He fell prey to the logical fallacy known as ‘induction’. This problem was mainly mooted by David Hume around 1748. Although the lives of Hahnemann and Hume overlapped by around 20 years, this particular medical problem was only really solved in the 20th century by the devising of the Randomised Controlled Trial (see the James Lind library1 for the history of fair testing of treatments).

    Homeopaths often justify dilution with the notion that it equates to greater potency of their treatment. In this case it would be dangerous to go for a swim in the sea. Sceptics often stage mass suicide attempts by overdosing on homeopathic medicines to mock this idea. On the plus side, homeopathic treatments will be entirely free from side-effects. Having said that, you would have to be wary of homeopathic plutonium, although diluted arsenic seems safe. 2

    Homeopaths could easily test their treatments in Randomised Controlled Trials, which are occasional positive but mostly unconvincing due to a lack of vigour. 3 Unfortunately, although there are fortunes to be made in the High Street from untested homeopathic medicines, there is no motive to subject these treatments to formal testing as there is very little regulation. This is in sharp contrast to the punitive levels of regulation for pharmacologically active medicines. 4

    But is any harm done by this inoffensive quackery? The NHS provides expensive homeopathic hospitals and prescriptions. This money could be better spent. We are also undermining medical research and science in people’s minds. Many people argue that it is only a placebo. Placebos are deception. It is not widely known that the so-called ‘placebo effect’ is hotly disputed 5 and is in fact a natural consequence of the phenomenon known as ‘regression to the mean’ where patients’ symptoms get better simply due to the passing of time. 6 By displacing real medicine and health care, the NHS has to pay twice due to any subsequent harm caused by the delay in treatment. There are dangerous parallels to the anti-vaccination movement in both the developed and developing worlds. Misplaced middle-class concerns with the scientific method ultimately undermine the concept of universalism and institutions that help the poor and those with the greatest need.

    1 http://www.jameslindlibrary.org/
    2  David Shaw. Homeopathy and medical ethics. Focus on Alternative and Complementary Therapies 2011; 16; 1: 17-21.
    3 Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy.Lancet2005; 366:726-32.
    4 McMahon AD, Conway DI, MacDonald TM, McInnes GT.The Unintended Consequences of Clinical Trials Regulations.PLoS Medicine 2009; 6; 11: e1000131.
    5 Hróbjartsson A, Gøtzsche PC. Is the placebo powerless? Update of a systematic review with 52 new randomized trials comparing placebo with no treatment.Journal of Internal Medicine 2004; 256; 2:91-100.
    6  Bland JM, Altman DG. Some examples of regression towards the mean. British Medical Journal 1994; 309: 780.

    Dr Alex D McMahon is Reader in Epidemiology, University of Glasgow

    From Healthier Scotland: the Journal

    SHA and homeopathy

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    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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    The crisis in mental health has been long foretold, as I heard these problems from 2007-12 when I sat as a patient representative on committees such as Improving Access to Psychological Therapies (IAPT), and Listen to the Voice of Experience (LIVE) The report in 2012 by the London School of Economics said that 750,000 mental sick patients are untreated.

    In 2009, I envisioned community mediation centres as a solution, and in 2010 I founded SECTCo (Social Enterprise Complementary Therapy Company) to contract with commissioners to provide meditation courses in Brighton and Hove. This paper sets out a summary of my vision.

    To solve any problem, one has to discover the cause, and remove it. The cause of the crisis in the mental health service is antidepressants, which are doing more harm than good. They are supposed to be taken for just a few weeks to ease your symptoms while you reduce stress, but are addictive, so patients end up taking them for life. They do not even claim to be effective in healing or curing your mental sickness, and create side effects which make you keep coming back, gridlocking the primary care system.

    In 2006 the government identified a solution – IAPT- which was supposed to ‘end the Prozac nation’, with one to one Cognitive Behaviour Therapy (CBT) but IAPT hasn’t worked hitherto because CBT only works for about 1 in 10 patients, confirming paragraph 7 of the above article. With nothing else to give patients, antidepressant prescribing has since nearly doubled from 30 -54 m monthly prescriptions pa. Primary care is overwhelmed because the number of patients on antidepressants has doubled from 2 to over 4 million.

    The solution is to get them all off antidepressants, by making IAPT work through ‘medication to meditation’. The talking treatment of choice should be changed from CBT to the NICE-recommended Mindfulness Based Cognitive Therapy (MBCT) 8 week course, which is 100 times more cost effective. This is because MBCT is effective in 2 out of 3 patients, and one MBCT facilitator and an assistant can ‘hold the space’ for 15 patients, all of whom get a good healing experience, learn self care, and receive peer support from other patients. There are no contra-indications, and MBCT courses can prevent and treat any mental sickness. It is clinically indicated to anyone with depression or anxiety, and should not be limited to only those who have had 3 previous bouts of depression. This was the entry requirement for the original trial in 2002 which got it NICE recommendation, because it showed that it halves the 5 year relapse rate, but it has since been shown effective for any addiction.

    The solution is therefore for IAPT to adopt the MBCT course as the core talking therapy in place of  CBT. Of course, funding is needed  but this should be provided by diverting funds from the prescribing budget, starting with antidepressants. This reaps the double benefit of providing an effective remedy, and saving adverse drug reactions from side effects.

    The solution is to create a system whereby GPs can prescribe NICE-recommended MBCT courses as easily as Prozac by voucher, which patients can cash for a course at meditation centres near each surgery within a few weeks, as described below.

    SECTCo’s experience running enhanced sandwich MBCT courses for donations in Hove

    I created SECTCo to facilitate MBCT 10 week courses, and have run 15 to date for donations for about 200 people who started and 100 who completed the course. Since the beginning of 2013 I have run them at a shop at 3, Boundary Rd Hove, BN3 4EH, assisted by former clients. We are presently open 2 days per week (Tuesdays and Thursdays), from 8am -5pm, totaling 26 hours per week.

    We have bid for public funding unsuccessfully, but if we were sufficiently funded, we could be open for 7 days per week from 8am to 930pm, totaling 94 hours per week. We provide a structure of drop in meditations around a core of the NICE-recommended MBCT course, supported by what we call the ‘enhanced sandwich’ MBCT course, under the following regime:

    0800-0900 Dynamic meditation every day of the week.

    0930-12 00 MBCT course on Tuesdays, with a MBCT facilitator course on Thursdays

    1200-1300 Kundalini meditation on Tuesdays and Thursdays.

    1400-1700 Family constellation groups on Tuesdays and Thursdays.

    In future, we would like to offer in addition in the evenings:

    1730-1830 Kundalini meditation

    1900-2130 MBCT course.

    Everyone seems to have benefited, and many of my clients have been able to break long standing addictions. I have trained about 30 facilitators who are ready and willing to teach this course if funded. If every surgery in country had a meditation centre like this near them, mental health could be transformed

    This structure of meditations has been used for thousands of years in monastries and convents to keep people mentally healthy. In 1979, Dr Jon Kabat-Zinn adapted the Buddhist practice of watching the breath (called ‘vipassana’) to create the secularised Mindfulness Based Stress Reduction (MBSR) 8 week courses into public health care. This has been so successful that it has spread world wide. Dr Mark Williams created the MBCT course out of it. SECTCo provides the MBCT course for 2.5 hours per week for 10 weeks, and also offer additional meditations to make it accessible to all comers.

    For further details please see www.sectco.org.uk, and section 9 of www.reginaldkapp.org, particularly paper 9.76, ’47 meditation centres for heartsink patients at half the drugs budget saving £7 for every £1 invested’.

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    As a result of a remark on our Facebook page we have been challenged by Dr Jhund: Does the Socialist Health Association support Homeopathy?

    In the Charter for Health which we published in 1984 we said ” The beginning of alternatives to orthodox medicine are available on the NHS: some GP and Rheumatologists are learning osteopathic manipulations, and Homeopathy has always been available, though sparsely…All of these elements of choice can, and should be expanded.”

    Homeopathic medicine cabinet

    Homeopathic medicine cabinet

    We haven’t discussed homeopathy in the 30 years since that was published.  The House of Commons cross-party Select Committee on Science and Technology said homeopathic medicine should no longer be funded on the NHS and called for a ban on the medicines carrying medical claims on their labels.  The theory behind homeopathy is utter baloney, and the evidence of effectiveness for some other alternative therapies such as acupuncture is  better. But its interesting that this was an initiative from the Science and Technology Committee, not the Health Committee.  Jeremy Hunt (and a few hundred other MPs) welcomed the positive contribution made to the health of the nation by the NHS homeopathic hospitals;

    We are of course, and always have been, in favour of evidence based medicine. But medicine is not only a science. There is much less good evidence to support common medical practice than most people imagine.

    Complementary medicine can be  helpful to people for whom conventional medicine has nothing to offer. The NHS does pay for some complementary and alternative medicine, mostly for people who are terminally ill, or have severe and enduring mental illness.  Nobody gets homeopathy on the NHS when evidence based treatment is available. We think this is defensible.

    What I said which has upset Dr Jhund was my very guarded defend of homeopathy.  “Homeopathy does no harm and it’s cheap. NHS wastes money in much worse ways.”

    The arguments against homeopathy boil down to these:

    • There is no evidence that it works any better than placebo
    • It spreads and legitimises a magic and unscientific view of the world
    • Its a waste of money which could be better spent
    Those arguments are, in their own terms, entirely correct, and I don’t think any member of the Association would dissent from them.  Its obvious that if homeopathy worked as described by its supporters we would all be cured of all our illnesses because the memory of the remedies would be in the public water supply.  But people in the NHS do not use complementary therapies in the way the critics imagine. This is not a consumer choice for believers when an evidence based treatment is available.   They are used with people whose problems are not amenable to evidence based medicine, and especially where an evidence based approach may be counter-productive.  For these patients something which relieves their anxieties and enables them to cope with their problems a bit better if often all that is hoped for.
    Nobody seems to know how much money is spent by the NHS on homeopathy. The Department of Health say “there are currently four homeopathic hospitals in England, and in the region of 25,000 homeopathic items are prescribed each year. Total costs are thought to be in the region of 3-4 million a year.”  The homeopathic hospitals actually provide a variety of complementary medicine, not just homeopathy, so that may be an over-estimate.
    All the arguments against homeopathy apply with equal, indeed greater,  force against religion in all its forms. Every hospital has a chaplain. Often a team of chaplains. The cost to the NHS of organised religion is several orders of magnitude greater and the damage done globally by religion is much greater than any done by homeopathy.

    Large numbers of patients visit doctors and hospitals daily and  repeatedly with symptoms which are medically unexplained.  They are often convinced that they are seriously ill.  Their doctors generally think that their problems are primarily psychological, but these patients are often sent to hospital for investigations and to visit consultants in order to exclude their anxieties about the  possibility of organic disease.  This process reinforces their anxiety and their belief in their illness which is so mysterious that doctors cannot explain it.  These tests and investigations have their own clinical risks which are quite significant. That seems a good deal more damaging than a bit of water and mumbo-jumbo.

    A lot of fuss is made of the cost of the homeopathic hospitals, but it seems to have escaped the notice of their critics that they don’t contain any beds.  Only the memory of beds.

     

    See also:

    The Case for Homeopathy Dr Susan McAllion

    The Case Against Homeopathy  Dr Alex McMahon

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    The NHS is a great and wonderful creation from our post war years when we were trying to make a better, healthier and fairer society. It is a thing to be proud of – and many wonderful people work in it. The only problem with it is that it is only offering only one kind of medicine and that is pharmaceutical medicine. And the only problem with that is that it will never bring about real health in a society. Pharmaceutical medicines, if used continually and exclusively, will eventually destroy health not create health. To create health we need to use systems of healing that promote the body to heal itself.

    If we only use a system that ‘does it to the body’ – as pharmaceutical medicines do – we will eventually weaken and disrupt the systems our bodies have evolved to heal themselves. If we then use further pharmaceutical medications to deal with the effects of our body having been weakened by the previous drug we begin our journey on the ‘cascade of intervention’ that all too often occurs in pharmaceutical medicine.

    If we go to the GP with a minor complaint – such as conjunctivitis – and are given antibiotic eye drops – the conjunctivitis may well be cleared by the next day. If we come down with a nasty cold 10 days later we might not see any connection to the conjunctivitis we cleared with the antibiotic drops less than a fortnight before. If we then take a decongestant and Lemsips with anti pyretic paracetamol in them we might find that we soon develop sore glands and ears and we are told by the GP that we have otitis media and should take oral antibiotics. No connection would have been made by the GP or us that there is a time line at work here: eye to mucous membranes to ear and lymph glands.

    From this last prescription we soldier on – have to keep going at all costs – and before we know it we have a dull pain in our back on the right hand side and back to the GP we go : kidney infection is diagnosed – and bingo! more, stronger antibiotics and anti inflammatory drugs to help with the pain. After this onslaught – and still we do not rest and recuperate – we begin to suffer from malaise and indeterminate symptoms – flu like, sinus pain, cystitis, loss of energy or loss of libido. Our body craves sugar – especially in the afternoons and we need strong coffee every morning before we can even open our eyes to face the day. The other thing that has happened is that our sleep has gone haywire – so back to the GP and onto the sleeping pills to try to right this wrong.

    By now with bad sleep and many low level symptoms we are getting in a state of nervous tension and depression. We get into arguments and have low mood and soon we are told we are depressed and need to go on an anti depressant. And the rest is – as they say – history.  All for the want of a remedy for the sticky eyes where this all started. I know an old lady who swallowed a fly….

    So now let me imagine the National Real Health Service of 2020 :

    The sticky eyed patient wakes up and prizes her pink eyes apart with the use of an old chamomile teabag. She then goes to her on-line GP surgery where she is asked to choose the healing system she wants to use from the front line services available : homeopathy, acupuncture, herbalism, Ayurveda, aromatherapy, acupressure, reflexology etc etc – the list – as we know – is endless. She makes her choice, types in her presenting symptoms, with concomitants and modalities and is sent back an immediate first aid remedy, from the medical tradition of her choice, to use while she is waiting for an appointment. Good nutritional advice is given at every contact and the golden rule for quick resolution of acute infections : plenty of water, garlic and vitamin C, no caffeine and no sugar until symptoms subside.

    The NRHS appointments system then offers her an appointment at the first available opportunity with the practitioner of her choice and with the healing system of her choice and she is seen within 48 hours – sooner if it is necessary. At this point the patient has a 45 minute appointment where she is treated holistically and the sticky eyes are put into a context with what else is going on with her body, her emotions and her mind. A treatment is given. Her own immune system is triggered into action and  she moves on towards shining health and vitality. So the old lady swallowed the fly – and that was all she swallowed – and she soon coughed it up and out again.

    This vision of a Real Health Service would not preclude Western Medicine, but WM would take its place in the great panoply of healing which would reflect our many cultures and our differences. One system does not suit all and the non-suppressive treatment of small, acute illnesses will bring about strong immune systems and healthy people. Primary care means the front line of care – so bring on the Real Health Service and ensure the front line is made up of a rich seam of health-bringing systems of care.

    Rix Pyke : rixpyke@btinternet.com

    Great spirits have always encountered violent opposition from mediocre minds. .. Einstein

    First they ignore you, then they ridicule you, then they fight you, then you win …    Gandhi

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