BMA meeting: BMA representatives vote to ban homoeopathy from the NHS

It is disappointing that Dr Lewis declined my offer of lunch. It
seems he misunderstood my letter, which was not to do with changing his
mind nor saving his soul, only a plea for better communication across the
divide, and for critics of homeopathy either to moderate their language,
or to justify their intemperate choice of words. I had hoped that over
lunch he would describe in more detail the charlatan status he had
bestowed on me. The better for me to deal with it.

Dr Lewis says that he has studied the science, and found homeopathy
wanting, no better than placebo. That is his right. Disinterested
observers might think otherwise, and can make a start at
www.britishhomeopathic.org . Likewise, medical homeopaths have studied
the language that he and his fellow critics use. We are perplexed. What
have we done to deserve such epithets ?

Dr Lewis writes that there is nothing to squabble about. Then why
liken professional colleagues to charlatans ?

Medical homeopaths and disinterested onlookers must wonder what
fuels the colourful and dismissive language that our critics favour ? Two
recent books, unlikely sources at first sight, provide starting points
for discussion.
Wilkinson and Pickett (1) devote a few pages to reviewing psychologists’
findings on the changing nature of self esteem in recent decades, and how
this might influence behaviour.
Iain McGilchrist (2) , in the course of a formidable tome, offers some
fascinating insights into the roles of the left and right hemispheres, in
producing contrasting perceptions and reactions, at individual and
cultural levels.

Medical homeopaths, running to their dugouts as another barrage of
critical flak threatens, could do worse than grab their copies of these
books, en route.

The lunch invitation remains open !

(1) Wilkinson and Pickett. The Spirit Level. (Allen Lane.) p40 et
seq.
(2) Iain McGilchrist. The Master and his Emissary. The Divided Brain and
the Making of the Western World. (Yale.)

Competing interests:
occasional homeopath, unpaid.

Rosiglitazone, a drug introduced to the market in 1999, is “unusually
good” at reducing blood sugar. [1] Rosiglitazone has also been a nice
little earner for GSK: annual sales peaked at $2.5bn in 2006.

The NHS spends £4m per year on homeopathic services and £152,000 on
homeopathic remedies. [2] No patient is harmed but delegates at the recent
BMA conference claimed that no patient benefits from homeopathy any more
than might be expected from a placebo treatment.

Rosiglitazone brilliantly lowers blood sugar but a landmark meta-
analysis in 2007 showed a 43% increase in the risk of heart attack while
taking the drug. GSK was notified in 2003 about an unusually large number
of reports associating rosiglitazone with heart problems. The risk was
real and GSK - and its previous incarnation SmithKline Beecham - had
actually known of those risks for more than a decade: they buried the data
while billions of dollars poured into corporate coffers. [3]

There is absolutely no evidence that homeopathy causes heart problems
or any other sort of problem to patients: many people seem to be helped at
very little cost. However, these facts did not stop one delegate at the
BMA conference, provocatively likening homeopathy to witchcraft and
facetiously apologising to witches who were "apparently offended by the
association with homoeopathy."

It would seem that GSK has given way to the mischievous burial of
negative evidence. The NHS has apparently given way to incompetence and
corporate greed, while the BMA has given way to an incompetent and
misguided band of witch-hunters. The mischief makers should apologise to
the homeopath, the good scientist and the patient, taxpaying or otherwise:
they all deserve an apology – a big one.

[1] Diabetes drug 'victory' is really an ugly story about
incompetence. Rosiglitazone has been a magnet for disappointing behaviour
since it was first marketed in 1999. Ben Goldacre, The Guardian, Saturday
17 July 2010.
http://www.guardian.co.uk/commentisfree/2010/jul/17/ben-goldacre-diabetes-
drug

[2] Homeopathy is "witchcraft" and the National Health Service should
not pay for it, the British Medical Association has declared. The
Telegraph, Laura Donnelly, Health Correspondent. 15 May 2010.
http://www.telegraph.co.uk/health/alternativemedicine/7728281/Homeopathy-
is-witchcraft-say-doctors.html

[3] Diabetes Drug Maker Hid Test Data, Files Indicate. The New York
Times, Gardiner Harris. July 12, 2010.
http://www.nytimes.com/2010/07/13/health/policy/13avandia.html?_r=1&src=...

Competing interests:
None declared

I trust Mark Struthers' questions are genuine, and that the best
valid RCT scientific evidence will be acceptable in response ?

If it be so, can we both agree that homoeopathy is as good as
placebo, neither worse nor better ?

Can we then agree that RCT evidence of Statins vs. placebo will
therefore allow a direct answer to his questions ?

QUESTION 1: In 2002, the NHS spent £550m on statins and £700m the
following year, with the predicted cost to the NHS rising, by 2010, to a
colossal £2.1bn. [2] The statins stride high on stilts. Of course, The NHS
would expect the benefit profile to be high on stilts too. I wonder if
that’s true ( ? )

ANSWER 1.

In 2002 Simvastatin cost the NHS £30 per month per person, but it came off
-patent in 2005 and dropped to £4.87 per person per month.

Cost savings (£) per life year gained from Simvastatin 40mg , at 2005
pricing, was calculated by the HPS investigators (ref 1):-

10-yr CVD Risk:

 Age		10%	20%	30%	40%	80%
==========================================================
40 - 49	        440	880	990	1010	990

50 - 59	        370	630	680	 760	720

60 - 69	        140	360	400	 440	400

70+ 	        -80	 70	160	190	140

QUESTION 2: What is the evidence for statin benefits?

Despite the oft-quoted fact that death-rates of women were not
statistcally significantly different in 4S, Metanalysis in 2005 of
secondary prevention trials showed large and consistent 30% reductions in
CHD rates and 20% reductions in mortality rates (ref 2)

In primary prevention it is true that benefits diminish rapidly as
CVD risk diminishes, both for individuals and populations, as Des Spence's
WOSCOPS 'treatment paradox' states. Most Individual patients get no
health benefit at all, since individual benefit is a direct function of
numbers needed to treat ( NNT), which is itself simply the reciprocal of
Absolute Risk Reduction (ARR). Only that 1 person in an NNT of 100 will
gain. However, there is a real reduction in disease for populations, 30%
better than placebo (ref 3). The aforementioned NET cost-saving to the
NHS is confirmed by NICE's economic evaluations.

Despite the recent re-hashed mta-analysis of Statins in Primary
prevention, where Ray et al remove hundreds of patients post-hoc from the
published primary prevention trials ( claiming them to be 'secondary'
contamination) the real reduction in disease holds up significantly. Only
be removing the 'high-risk' or so-called secondary cases post-hoc, is the
mortality benefit attenuated to zero, leaving a population with a mean ten
-year CVD risk of 11% (on placebo). Such a low-risk population is widely
acknowledged to be below the recommended 20% CVD risk threshold for
treatment by NICE. People with pristine vasculatures are not expected to
benefit from statins at all. 30% of a zero risk is equal to no benefit.

QUESTION 3: What are the risks to quaffing statins?

Surprisingly few !! see ref 5.

Whereas homoeopathy is equal to placebo.

Opinion and rogue conjecture, however enjoyable provocative or
mischievous, should give way to quality RCT evidence.

Dr Sam Lewis

References:

1. Heart Protection Study Collaborative
Lifetime cost effectiveness of simvastatin in a range of risk groups and
age groups derived from a randomised trial of 20 536 people
BMJ Dec 2006; 333: 1145; doi:10.1136/bmj.38993.731725.BE

2. Efficacy and Safety of cholesterol-lowering treatment: prospective
meta-analysis of data from 90 056 participants in 14 randomised
trials of statins
Cholesterol Treatment Trialists' (CTT) Collaborators
The Lancet
Volume 366, Issue 9493, Pages 1267-1278
(October 2005)

3. The benefits of statins in people without established
cardiovascular disease but with cardiovascular risk factors: meta-analysis
of randomised controlled trials
BMJ 2009;338:b2376, doi: 10.1136/bmj.b2376 (Published 30 June 2009)
Brugts, J J et al. BMJ 2009;338:b2376

4. Statins and All-Cause Mortality in High-Risk Primary Prevention
A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229
Participants
Ray, K. K. et al. Arch Intern Med 2010;170:1024-1031.

5. Unintended effects of statins in men and women in England and
Wales: population based cohort study using the QResearch database
Julia Hippisley-Cox and Carol Coupland
BMJ 2010;340:c2197, doi: 10.1136/bmj.c2197 (Published 20 May 2010)

Competing interests:
None declared

I have never treated anyone homoeopathically. Nor have I studied
homoeopathy. However I have seen homoeopathy succeed - in the hands of
registered medical practitioners. How it works is no concern of mine; if I
am ill I want to get better.

It was a very unwise vote by the BMA.

JK ANAND

Competing interests:
Please see the text