NHS should stop funding homoeopathy, MPs say
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1091 (Published 23 February 2010) Cite this as: BMJ 2010;340:c1091
All rapid responses
Homeopathy is the most mythical field in alternative medicines.It also
the least regulated and standardised.There are a lot of Practitioners who
are not qualified.My personal experience is it works on lots of chronic
minor ailments but is not very useful in acute medical illnesses.
I have had exposure to homeopathy when i was about 13 years old.I suffered
from chronic tonsillitis with frequent exacerbations.Finally the GP in
modern medicine referred me to ENT specialist who advised on tonsillectomy
as soon as feasible.We,including my parents, did not like the idea of
Surgery.We thought we could try homeopathy.I was on homeopathic treatment
for 4-6 months.I was relieved of symptoms .Forty years on I still have my
tonsils but with no problems.But I have known people who have had problems
with homeopathy when they have had treatments for acute conditions.
The only way forward is for the homeopathic practitioners to show
evidence based practice and open up more for scutiny and better regulation
Competing interests:
None declared
Competing interests: No competing interests
Looking for evidence is not only neccesary for homeopathy.
Most of the regular GP's or dentist's work is not EBased; led that be
understood well! A lot of daily practice is against existing evidence.
Let there be good research including all kinds off therapies.
There's a lot we don't know yet and real researchers don't throw away
thoughts too early.
Competing interests:
CAM Dentistry
Competing interests: No competing interests
I urge everyone involved in this debate to read the following
scientific paper (not just the abstract) from researchers at the
University of Texas, just published in the International Journal of
Oncology.
Cytotoxic effects of ultra-diluted remedies on breast cancer cells,
Frenkel et al, International Journal of Oncology, February 2010, Volume 36
Number 2.
Competing interests:
Medical journalist,
Registered Naturopath
Competing interests: No competing interests
Mr. Norman contribution makes claims against “homeopathic
researchers” and yet provides no references to whom he refers.
If he is pointing his finger at me, it is a tad strange that he has
not chosen to respond to any of the controlled clinical trials I have
referenced above. He seems to epitomize the very same problems to which
he blames homeopaths. BMJ readers deserve more substantative comments.
In responding further to Mr. Norman’s comments, any advocate OR
skeptic of homeopathy that says that randomized double-blind placebo
controlled trials “cannot” be done is simply showing their ignorance of
homeopathy and the scientific method. Such studies ARE possible, but good
research on homeopathy must be respectful of the homeopathic method. Good
science requires internal validation as well as external validation. Just
because a trial is “perfectly” conducted according to DBPC standards does
not necessary mean that it is good science. One can conduct a perfect
DBPC trial, but if you use the wrong drug for the wrong condition, it
isn’t good science (whether this research is testing homeopathy or
conventional drugs).
Many trials are set-up to test a SINGLE homeopathic medicine for
everyone with a specific disease. There are a small number of instances
in which one specific homeopathic medicine has a history of efficacy in
treating a specific disease (such as Oscillococcinum in the treatment of
influenza, Kali bichromicum in the treatment of people with COPD and who
have increased tracheal secretions, and a couple of others), however, the
vast majority of homeopathic medicines require individualization of a
patient’s syndrome, not just their localized pathology. Testing only one
or even a small handful of homeopathic medicines will often not be an
adequate test of homeopathic treatment (such studies have inadequate
external validity).
Ultimately, the House of Common’s Science and Technology Committee’s
Report will prove to be an embarrassment to the British government. It
was so sloppy and so academically weak that it did not differentiate
between homeopathic medicines that are “low potency” and “high potency”
doses. Boots and most pharmacies sell homeopathic medicines that are in
“low potencies” and for which there are molecular amounts of medicinal
agents in them, and there are literally thousands of studies in the field
of hormesis (the science of low dose effects) that show the biological
activity of homeopathic medicines (1)(2). Further, a recent report from
the highly respected Cochrane Collaboration showed the benefits of low
potency homeopathic medicines for people with cancer (3).
Lumping together ALL types of homeopathic medicines is simply sloppy
thinking and is akin to those who are pro-homeopathy and/or pro-CAM who
say that all vaccines are ineffective or all surgeries are “bad.” Such
lumping together various treatments is intellectually weak, for good
science requires much greater specificity and detail. Finally, when
science gets smug, it gets sloppy, and
science and medicine wilts.
(1) Calabrese, Edward. Hormesis: a revolution in toxicology, risk
assessment and medicine. EMBO 5,2004: S37-S40.
doi:10.1038/sj.embor.7400222.
(2) Calabrese EJ, Linda A Baldwin LA. Applications of hormesis in
toxicology, risk assessment and chemotherapeutics. Trends in
Pharmacological Sciences, Volume 23, Issue 7, 331-337, 1 July 2002.
doi:10.1016/S0165-6147(02)02034-5.
(3) Kassab S, Cummings M, Berkovitz S, van Haselen R, Fisher P.
Homeopathic medicines for adverse effects of cancer treatments. Cochrane
Database of Systematic Reviews 2009, Issue 2. Art. No.: CD004845. DOI:
10.1002/14651858.CD004845.pub2.
Competing interests:
Author/publisher/educator specializing in homeopathic medicine
Competing interests: No competing interests
The controversy over homeopathy’s NHS funding, and to a lesser extent
complementary medicine generally, seems to take one of two possible
viewpoints.
The first viewpoint is that as there is no evidence that these
therapies work, there is no reason to research them and no justification
to fund them publicly. Homeopathy and other therapies are scientifically
implausible, so where there is research with a statistically significant
effect it is probably flawed.
In addition as these therapies do not work it is unethical for them
to be practised and to regulate them would be to mislead the public into
their effectiveness – as any effect is placebo. Indeed their practice
should be actively discouraged.
The second viewpoint is that there is some evidence that homeopathy
and other therapies work including a small number of statistically
significant RCTs and meta-analyses 1. Homeopathy precedes the modern
research paradigm by 150 years and herbal medicine by 2000 years. They
have been used in a wide range of conditions and only a fraction of these
have been researched.
An absence of evidence does not mean an absence of effect. Many of
those who practice are trained in the scientific approach but observe
effects which are difficult to explain by placebo alone.
Thus with the combination of public demand, longevity of use,
inconclusive evidence and positive outcome studies (70% report benefit
with homeopathy 2) it seems pragmatic to both regulate these professions
and continue funding research into them.
Which of the above two viewpoints are chosen seems to be largely a
matter of opinion rather than scientific fact. However, the opinion
becomes reality if it drives policy affecting patient access to
complementary medicine.
Dr Edward Thompson
1. 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: 834–843.
2. Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for
chronic disease: a 6-year university-hospital outpatient observational
study. Journal of Alternative and Complementary Medicine, 2005; 5:
793–798.
Competing interests:
Homeopath, Herbalist, Acupuncturist
Competing interests: No competing interests
One Saturday morning in 1990 I rose at 5am to drive to
Glasgow for my first training session in homoeopathy, run by
the Faculty of Homoeopathy. It sounded like a pukka enough
organisation for the homoeopathic course to be worthy of my
attention as a well-educated graduate of an illustrious
Scottish medical school. I was, by virtue of that training,
a clinical scientist and although open-minded I was
sceptical that I might be en route to a course in some
benign sort of black magic. By then I had over 10 years’
experience of doctoring, four of them as a principal in
general practice. I had increasingly found in my daily work
that the limitations of what I had learned in acquiring my
MB ChB in dealing with patients were rather extensive. I was
looking for some other string to my therapeutic bow, hence
the early morning trip. Nonetheless, I felt that experience
was driving my clinical skills to improve. When I tried to
analyse what was behind that development I began to
appreciate that a key ingredient of what I used in treating
patients had nothing to do with my knowledge of the BNF or
what I had written on the GP10 prescription pad. Part of the
prescription was me.
I may have already been beginning to move in the right
direction as a clinician, as we all hope to do, but that
first homoeopathic training session propelled me forward
with a jolt. There was something about the vibe in the room
but particularly the connection with the speakers that
opened doors in my head that until then were only just ajar.
I have used homeopathy ever since. Not regularly – I am
mainly an allopath. But sometimes it just clicks that this
is the right approach for this patient with these problems.
It does not always work, yet it does the trick often enough
to make me use it again. Examining homoeopathy from the
standpoint of conventional drug pharmacology makes it look
ridiculous. “There are no molecules of medicine in the
tablets!” “It’s the placebo effect!” Examining it from the
standpoint of a method by which a patient can be assessed
and helped to heal, it is not ridiculous at all. It does
help many people to “get better” – a topic that needs more
space than exists here but which is surely the essence of
what we try to do as doctors for our patients.
Homoeopathy does indeed have several problems that confound
its analysis beyond the obvious restrictions imposed by the
Avogadro constant. An outstanding feature of the trainers on
that homeopathy course was their superlative ability to
communicate. I subsequently learned that they were equally
empathic with their patients. The interaction with the
homoeopath is a fundamental part of the homoeopathic method,
which cannot be replicated by treating homoeopathy as a
branch of clinical pharmacology. That the therapist is part
of the prescription is a problem of sorts for homoeopathy.
It means that, outside of the first aid remedies that one
can buy at any pharmacy, homeopathy needs usually to be
delivered, not merely taken. Homoeopathy may really be a
form of psychotherapy in which the process of finding the
“remedy picture” and the compliance with the prescription
form the underlying structure of why it works at all. In my
view, analysing homoeopathy as if it were drug therapy will
always fail. Instead it should be analysed by methods much
more akin to those used in assessing psychological
treatments. We cannot afford to dismiss homoeopathy – it is
too important a part of the full spectrum of healing methods
available to us. Equally, those who advocate homoeopathy
need to accept that the sceptics do have a point. Parties on
both sides of this argument may be failing to understand
what homoeopathy is fundamentally about.
Competing interests:
None declared
Competing interests: No competing interests
Homeopathy is curing by similars. The dose size is a secondary
application. The word homeo means similar, not small. Hahnemann even
refers to treating scalding caused by hot water, by the application of
warm water rather than the traditional use of cold water. Warm is similar
to hot, whereas cold is opposite of hot. The key factor is to get
something similar to the suffering of the patient.
This applies to injuries too. Someone hits a finger with a hammer; get the
person to lightly touch the hammer to the finger in a similar way to how
the injury occurred. The injury will rapidly heal. The treatment was
homeopathic without any medicine being used. If it is not possible to do
this physically, it can be done as counselling: “Tell me what happened.
Start at the beginning and recount it”.
Many early medical homeopaths, who were successful in their practice of
homeopathy, only ever used low potencies, that is, physiological doses.
They were using homeopathy in the true sense of the word.
It would be useful if the media were given this information.
On the subject of dilution and high potencies a certain Dr Boyd performed
a series of 500 experiments to test and prove the concept. This is written
in the British Homeopathic Journal and reported in the Journal of the
Royal Pharmaceutical Society.
The result of this experiment with homeopathy was printed in the
Pharmaceutical Journal on September 11th 1954.
Copies are available from the Royal Pharmaceutical Society via Martha
Krumbach,
Information Access and Resource Manager (Librarian),
Royal Pharmaceutical Society of Great Britain,
1 Lambeth High Street,
London
SE1 7JN, email: martha.krumbach@rpsgb.org
Dr Boyd's research was also reported in the Daily Telegraph of 19th
August1954.
Dr Boyd’s work can also be accessed on Science Direct which leads to
this summary:
1. A method is described for investigating the possible action of
microdoses of mercuric chloride on the hydrolysis of soluble starch with
malt diastase.
2. The microdoses of the mercuric chloride used in the latest crucial
series carried out in1946, 1948, and 1952, were what are termed “high
potencies” made in accordance with the pharmaceutical method of
preparation of drugs ordinarily used in the practice of homœotherapy.
3. These microdoses were prepared by separate stages of dilution, the
solution at each stage being subjected to mechanical shock. The solutions
were, theoretically, “dilutions” of the order of 1 in 10(−61) and on
present physical theory would not contain any molecules of the original
mercuric chloride.
4. The difference in rate of hydrolysis between flasks containing
starch, diastase, and distilledwater (controls) and flasks containing
starch, diastase and microdoses of mercuric chloride (tests) were compared
colorimetrically by the Spekker absorptiometer, and the frequencies of the
differences statistically analysed, as the results obtained showed
biological scatter. More than 500 such comparisons were carried out. The
differences of means were examined by the Fisher “t” test, the variances
tested and Cochrane and Cox's test applied where indicated. All the series
gave a highly significant difference in the rate of hydrolysis between
controls and tests, the microdoses stimulating the process. Statistically
the significance is shown by the fact that a probability of <_0001 was="was" obtained="obtained" independently="independently" in="in" each="each" of="of" the="the" three="three" years="years" _1946="_1946" _1948="_1948" and="and" _1952.="_1952." control="control" results="results" gave="gave" an="an" approximately="approximately" normal="normal" distribution.="distribution." p="p"/> 5. The distribution, control methods, and accessory control
procedures were considered toexclude, as a cause of the effects,
adsorption of the original drug and the presence of extraneous
contaminants by chance solely in test flasks. The only difference between
control and microdose flasks was the addition of microdose, the distilled
water being common to both controls and tests.
6. It was concluded that a factor, unidentified, derived from the
mercuric chloride used, was present in solutions prepared by serial
dilution with mechanical shock which could affect the distilled water
diluent, that this change was transferable to subsequent “ultramolecular”
stages of “dilution”, and that this factor was the source of the activity
in the microdose solutions producing the acceleration of the rate of
hydrolysis.
7. In an addendum there is described recent biological work which is
also providing evidence of the presence of an active selective factor in
“high potencies” derived from Strophanthus sarmentosus by the same methods
of dilution with mechanical shock.
Competing interests:
Homeopath and Registered Naturopath.
Competing interests: No competing interests
I have come across two individuals who responded to homoeopathic
treatment prescribed by national health service doctors.
Was it magic? Was it placebo? I care not for the rationale. When I am
ill, I want to be made better.
I request the government:please continue to provide homoeopathy on
the NHS, in the NHS.
I never practised homoeopathy and I have no financial interest in it
nor in "allopathy".
Would the BMJ care to conduct an anonymous servey of NHS GPs to
discover what percentage have, or would seek homoeopathic treatment if
"allopathy" failed them?
JK ANAND
Competing interests:
Please see the text
Competing interests: No competing interests
Having just re-read Mr Ullman's most recent contribution, I was stuck
by a contradiction: Ullman claims strongly that there IS double-blind
placebo-controlled evidence in reputable journals that does support action
by ultra-molar homeopathic remedies (albeit for what seems strained
environments and conditions). Therefore those "in the know" about
homeopathy believe that ultra-molar remedies CAN be subject to PCDB
trials, and what's more they produce positive results.
And yet this seems to contradict strongly what a very large body of
knowledgeable homeopaths have claimed for some time now: That ultra-molar
remedies, by their very nature and use, CANNOT be subject to PCDB trials
due to "individualised case requirements" or whatever. This was a major
cornerstone of their objections to such trials in the past. I even recall
Ullman being another voice among them taking this point of view.
I suggest to Ullman that he can't have this both ways and still
retain credibility. Either homeopathic remedies can be trialled like any
other drugs, or they cannot. But the notion of selectively switching
testing candidacy in and out purely as a convenience is not the least bit
scientific at all.
Reading further afield on the subject of "proof of homeopathy", it
becomes rapidly clear that the vast majority of proofs fall into three
broad categories:
1) Name-calling, usually in the form of a virulent attack on
"allopathy". Such "evidence" is entirely irrelevant to supporting
homeopathy and usually can be discarded immediately.
2) The Argument from Popularity, also a logical fallacy. This
usually in the form of "X million people use homeopathy so it must be
valid." The obvious response is billions of people also believe the world
is flat - so therefore it must be so. Again, with caution, such proofs
are almost always discardable immediately.
3) Misrepresented or Poorly understood reporting. This is tricky to
resolve quickly. However there is a short-cut: It is sadly surprising
that most "homeopathic researchers" who trumpet this evidence have merely
found it using text search engines but then have failed significantly to
read and comprehend the content. Oftentimes their brandished proof will
contain clearly-stated conclusions the exact opposite of what they claimed
it actually said. For recent examples, I refer readers to the reports
submitted to the parliamentary review board.
I use these three basic filters quite a deal when doing the first
pass of such claims. Frequently, nothing at all falls out the other end.
So I invite readers to do the same with Ullman's claims, and see if they
attained the same results I did.
Competing interests:
None declared
Competing interests: No competing interests
The Future of Homoeopathy in NHS: At Crossroads ?
Homoeopathy is an alternative system of medicine founded by German
physician; Samuel Hahnemann (1755-1843). The first edition of his
classical text ‘The Organon of Medicine’ appeared in 1810.
Homoeopathy relies on patient’s description of his / her own symptoms and
lifestyle. A homoeopath relies on this type of individualization to find
the most appropriate remedy for a particular disease in a particular
patient. There have been some controversies regarding the uses of
homoeopathic remedies at very high dilutions or potencies where science
believes in the non-existence of even a single molecule. Still the
patients using such potentiated remedies are able to achieve desired
therapeutical outcomes – obviously, beyond the reach of orthodox
scientific explanation. Though homoeopathy may not have application in all
types of illnesses or trauma events, it can not robbed of its status as a
successful therapy in the treatment of environmental- or food origin-
diseases (such as hay fever, allergic rhinitis, eczema) and stress-origin
diseases (such as migraine and digestive problems).
Homoeopathy has been trusted by around 500 million people in the world and
has been listed by WHO as one of the traditional CAM therapies with
potential to provide health care throughout world if integrated with
modern medicine. Homoeopathy has carved a place for itself in the Europe –
particularly in Germany and France. In Britain, Homoeopathy was the only
alternative system to have its treating facilities at Bristol, London and
Glasgow under NHS. The fourth NHS facility – a hospital at Tunbridge Wells
had to face closure in 2008 due to withdrawal of funding. Physicians and
other healthcare providers such as nurses or pharmacists have the
opportunity to learn this system under Faculty of Homoeopathy (founded in
1950 by an Act of Parliament) in Britain. Practice of homoeopathy in
Britain does not require one to be medically qualified and probably such
liberalism under the law probably needs to be restricted so that there is
a clear distinction between professional and lay homoeopaths.
History has witnessed some degree of antagonism and distrust between the
practitioners and advocates of orthodox medicine and homoeopathy. It might
have been so because most of the early followers of Homoeopathy (including
Hahneman himself) came from orthodox or conventional medicine. Dr.
Frederick Quin – the introducer of homoeopathy in Britain was also
primarily trained in allopathy and turned to homoeopathy only after being
cured of cholera. He opened first Homoeopathic hospital in London in 1849.
During 1854 cholera outbreak, the mortality rates at this hospital were
less than those at allopathic hospitals. This fact has been claimed to be
suppressed apprehending the fear of popularity of homoeopathy contrary to
the general progress of science.
Its practice in Asia particularly India, Pakistan and Sri Lanka is
flourishing very fast to an extent that it has been integrated into the
national health systems in these countries. India for example has central
govt. establishments such as Department of AYUSH (Ayurveda, Unani, Siddha
and Homoeopathy), National Institute of Homoeopathy (NIH), Central Council
of Homoeopathy (CCH) and Central Council for Research in Homoeopathy
(CCRH) in addition to state govt. clinical, non-clinical and teaching.
Developed nations such as US have not remained unaffected by homoeopathy.
Dr. Constantine Hering (1800–80) and Dr. James Tyler Kent (1849–1916)
popularized the therapy in America. In a recent report submitted in US,
homeopathy has been classified as one of the professionalized health
system under alternative systems of medical practice. Council on
Homeopathic Education monitors and approves the quality of Homeopathy
courses offered to professionals in USA.
It is beyond comprehension as well as painful to know that British
parliamentarians want this magnificient system be excluded from NHS. Has
the contribution of Britain in the history of homoeopathy and therapeutic
outcomes from homoeopathic system in British population forgotten ? Let’s
hope that the second report under "Evidence Check" by the House of Commons
Science and Technology Committee is not influenced by allopathic medicine
followers, pharma industry and geographic bias. In my opinion, NHS does
not need to be a follower of nine other primary care trusts which do not
fund homoeopathy. Instead, it is expected to be trendsetter for others –
by conducting therapeutic audits within the framework of homoeopathy and
general science.
Further Reading:
1. Kmietowicz Z. NHS should stop funding homoeopathy, MPs say. BMJ 2010;
340: c1091.
2. Healy M, Aslam MA. Homoeopathic Medicine and Aromatherapy. In: Evans
WC, editor. Trease and Evans’ Pharmacognosy. 15th ed. London: W B
Saunders; 2003. p. 460-64.
3. Lockie A. Encyclopedia of Homoeopathy. Delhi: Dorling Kindersley; 2006.
4. Kayne SB. Homeopathy and Anthroposophy. In: Barnes, editor.
Complimentary and Alternative Medicine. 2nd ed. London: Pharmaceutical
Press; 2009. p. 187-268.
5. Kaul PN. Alternative Therapeutic Modalities. Alternative Medicine.
Progress in Drug Research. 1996; 47: 251-77.
6. Health Economics Program. Complementary Medicine: Final Report to the
Legislature. St. Paul: Minnesota Department of Health; 1998.
7. AYUSH Website: http://indianmedicine.nic.in/ accessed on Mar 08, 2010.
shoaibpharm@rediffmail.com
Competing interests:
Teaching Pharmacognosy (including Introduction to Systems of Medicine) for last seven years at University / College level).
Competing interests: No competing interests