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

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