Evidence 2011BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5572 (Published 01 September 2011) Cite this as: BMJ 2011;343:d5572
All rapid responses
When will doctors start talking about clinical evidence and its cost
1.Anti lipid drug menace,(year 2009)2.No clinicians left??(in year2011)-
Rapid responses to
Systematic Review: Comparative Effectiveness and Harms of
Combinations of Lipid-Modifying Agents and High-Dose Statin Monotherapy
Mukul Sharma, MD, MSc; Mohammed T. Ansari, MBBS, MMedSc, MPhil; Ahmed M.
Abou-Setta, MD, PhD; Karla Soares-Weiser, MD, PhD; Teik Chye Ooi, MBBS;
Margaret Sears, PhD; Fatemeh Yazdi, MSc; Alexander Tsertsvadze, MD, MSc;
and David Moher, PhD
Competing interests: No competing interests
Mr Richard Rawlings, Consultant Orthopaediatric Surgeon, explains that
he has provided, for the BMA's Board of Science, " briefing papers on
homeopathy, Reiki and the integration of alternative medicine systems with
orthodox science- based systems. "
Medical homeopaths see their service as complementary, not
alternative, to their conventional practice.
I assume that Mr Rawlings spoke widely with medical homeopaths, and
their patients, and that he is familiar with the homeopathic literature.
In recent years there has been much discussion of the role of
arthroscopy in the investigation and treatment of knee problems. The BMJ
recently detailed the concerns that BUPA has expressed about the alleged
overuse of this procedure (1).
The financial implications for patients, insurers, and the NHS, are
Not to forget patient discomfort and disability.
If I were to write a briefing paper on knee arthroscopy, with
reference to BUPA's concerns,and send it to the Advertising Standards
Authority, ( there are dozens of advertisements for this procedure on the
internet ), orthopaedic colleagues might suggest that I concentrate on my
own clinical performance, and tread carefully and with humility, in areas
where I lack experience.
No doubt Mr Rawlings discovered, in the preparation of those
briefings, that there are hundreds of NHS GPs using homeopathic remedies
as part of their service to patients. GPs find it very safe and
satisfying, patients are supportive and grateful. Side effects pose no
The cost of remedies is minimal, compared to conventional medicines.
There is a good case to be made that homeopathy saves the NHS money.
I am sure Mr Rawlings' briefing papers are models of their kind, and
I trust that any constructive proposals he has made concerning more
effective integration of homeopathy into the NHS, will see fruition.
1 BMJ 2011; 343:d4965
Competing interests: NHS GP, occasional homeopath, unpaid.
Homoeopathic products contain no active ingredients. They are not
medicines. They do not need regulation. And the MHRA do not need to go to
the expense of organising an advisory body.
BMA policy is clear: unless and until there is plausible evidence of
efficacy, no NHS funds should be expended on purchase of such products.
I have provided the BMA's Board of Science with briefing papers on
homoeopathy, Reiki, and integration of alternative medicine systems with
orthodox science-based systems. Doctors aim to satisfy patients, even at
the expense of sometimes having to set aside strictly rational practice.
These issues are simply too far down the agenda to have had serious
The MHRA should however act more responsibly and not seek to offer
any endorsement of pseudo-scientific practices. It should be held to
account by Parliament. "Patient safety" is not just a matter of their
physical circumstances but also their intellectual, and they must be
protected from intellectual harm as much as pharmacological.
I have no doubt a patient's experience of a constructive therapeutic
relationship with the caring homoeopath will provide "benefit". But that
is not a product. It does not need regulation.
MPs with sufficient understanding of science and the necessary
intellectual honesty, must ensure the MHRA is properly accountable, and
does not squander scarce resources on an unnecessary advisory body.
Competing interests: No competing interests
At a time of austerity cuts, when treatments that work should be
protected, it was depressing to see the Government's Advisory Board on the
Registration of Homeopathic Products advertising for four expert and
"eminent members of their profession" who can "assimilate complex
scientific information" to advise about the "safety and quality of
homeopathic medicines" . For this they will be paid ?325/day.
Homeopathy has definitively and repeatedly been proven to work no
better than placebo or nocebo. It is, in short, bogus. Professionals with
faith-based (rather than evidence or science-based) beliefs in homeopathy
may be recognised as eminent by their peers only in so far as those peers
think likewise. Indeed, the job specification specifically precludes
proper scientists and sceptical lay people since it requires applicants to take homeopathy seriously. In particular, why is a
pharmacist expert in pharmacognosy (medicines derived from natural
sources) required to advise about products that vanish after multiple
dilutions? The appointment procedure begs several questions of public
policy. The scientific community will be at best bemused and at worst
outraged over this ill-conceived process.
What possible purpose does this Board serve - other than to clothe
naked quackery and legitimise pseudoscience?
5th September 2011)
Competing interests: All the authors belong to Healthwatch-UK (a charity which promotes evidence-based treatment http://www.healthwatch-uk.org/). NR is the President of HealthWatch and a trustee of Sense About Science (which promotes, well... sense about science)