Health board’s decision to stop funding homeopathy is upheld by judicial reviewBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4797 (Published 08 September 2015) Cite this as: BMJ 2015;351:h4797
All rapid responses
I feel this ruling goes against the NHS idea of patient choice. We all pay for the NHS and we should all be able to choose the medicine we feel is most effective for us. There is clear data that demonstrates that those that use CAM rely less heavily on drugs and their GP. In this case the ruling deprives the patient of a safe and effective alternative. It also undermines a homeopathic doctors freedom to prescribe as they see fit for each patient. What I find most disappointing is that the public review has been ignored and an out dated argument about the efficacy of homeopathy seems to have been the deciding factor.
Competing interests: I work in homeopathy.
A 73 year-old women suffering from arthritis and anxiety and using homoeopathy has lost her legal battle vs Lothian Health Board decision withdrawing provision of an NHS homeopathy service and ceasing referral to the Glasgow Homeopathic Hospital.(1, www.scotcourts.gov.uk/search-judgments/judgment?id=f086e9a6-8980-69d2-b5...) Happily, health boards are not flying in the face of the evidence; money spent on unproven remedies would be better spent on evidence-based medicines. They are following the lead of the House of Commons Science and Technology Select Committee that advised ending funding for the prescribing of homoeopathy in the NHS.(2) Currently homeopathy products from community pharmacies cost NHS England roughly £110,000/year vs £900,000 in the mid 90s, and the decline occurred despite the Prince of Wales’ support.(http://www.nightingale-collaboration.org/news/172-the-further-decline-of..., 3) In France, evidence seems to be employed only randomly: the French Medicine Agency issued a warning letter when a producer of homeopathic remedies (i.e. diluted water) mixed up the vials’ labels (4) and homeopathy is reimbursed by the mandatory healthcare scheme (products cost roughly £730,000 without the consultations) despite the recommendation of the Institute Of Medicine.(5)
A French court has just awarded a £585/month disability grant to a woman claiming to suffer from electromagnetic hypersensitivity who has opted for a reclusive life in the mountains to avoid exposure to mobile phones, Wi-Fi routers and televisions. (http://www.theguardian.com/world/2015/aug/27/french-court-awards-woman-d...) However, in scientific trials, neither patients nor researchers are able to tell whether or not they are exposed to electromagnetic waves. French courts also compensate for claims of post-vaccinal multiple sclerosis or “macrophagic myofasciitis”.
The problem is not about scientific literacy and waste of resources but about access to adequate evidenced-based treatments. Those people feel unwell and really suffer because they believe they are sick or have been exposed to something harmful. Compensation can’t help but can only increase the consequence of false beliefs and victimisation. They are patients who deserve psychological support and cognitive behavioural therapy. Irrational thoughts can be challenged and strategies to change behaviour in a culturally congruent manner can be devised. While the NHS provides free treatment with qualified psychotherapists, in France treatment by psychotherapists is not reimbursed by the mandatory health care scheme.
With finite resources, every pound or euro misspent on quackery will be less to spend on treatments of proven value. It is time to start paying more than lip-service to evidence-based medicine. Otherwise, why not reimbursement for astrology to inform women when their labour will begin?(2)
1 Dyer C. Health board’s decision to stop funding homeopathy is upheld by judicial review. BMJ 2015;351:h4797.
2 Baum M. Homoeopathy waives the rules. Lancet 2010;376:577.
3 Ernst E. Complementary and alternative medicine. Lancet 2001;357:802-3.
4 Braillon A. Homoeopathic remedies and drug-regulatory authorities. Lancet 2010;375:279-80.
5 Guéniot M. for Commission II. [Should we continue to reimburse homeopathic preparations?] Bull Acad Nat Méd 2004,188:1071-73.
Competing interests: we are members of HealthWatch, a charity (#1003392) that has been promoting evidence-based medicine and integrity in healthcare since 1991.( http://www.healthwatch-uk.org/)
The BMJ has been at the forefront of recent demands that the pharmaceutical industry should make available all the evidence that it accumulates about the efficacy, clinical benefits, side effects and potential dangers of medications, before and during their use in clinical practice.
Only then, when suspicions are allayed, that published trial results may have been cherry picked, and that ambivalent or negative reports may have been kept hidden, can the professionals and the public be in a position to reach an informed decision.
The BMJ itself, and the professionals and public who rely on it’s avowed commitment to evidence based decisions, might not be impressed if, for instance, the Association of the British Pharmaceutical Industry (APBI) was chosen as an arbiter of the extent and nature of such disclosures, and their usefulness.
In this context it is interesting to consider the item by Clare Dyer (1) which details the rejection by a judge of the “ legal challenge to Lothian Health Board’s decision to stop funding homeopathy on the NHS.”
At a time of huge cash restraints on the NHS, this may seem unremarkable.
Dyer quotes the Good Thinking Society, “ which campaigns for an end to NHS funding of homeopathy .”
Dyer quotes the judge’s reasoning that the Board “ .accepted the view that there was no scientific evidence for the efficacy of homeopathy..“
The bigger the lie, the more likely that liars go unrecognised. The UK Chancellor of the Exchequer was, for the course of the last parliament, a party to the Big Lie that the previous Labour government was responsible for the budget deficit in 2008 and thereafter. The deficit was due to the global banking crisis, and the near collapse of UK banks. (2)
The BMJ is regularly the facilitator of another Big Lie. Instead of printing simplistic untruths, about “ ..no evidence for homeopathy ” the BMJ should follow it’s own advice to Big Pharma, and examine, in full, the evidence about the efficacy of homeopathy, making it’s readers more aware of the extent of that evidence.(3,4) Instead, it chooses to rely on the Good Thinking Society for guidance. Readers who are familiar with the website of the Good Thinking Society, and it’s partisan approach, may wonder why it enjoys a status, as an informant, that the BMJ might not afford to the APBI.
Homeopaths are tired of being accused of deceiving their patients, in your columns, although the worst abuse which used to characterise comments by distinguished denigrators of homeopaths has all but disappeared. Perhaps they finally realised that their abuse, if accurate and truthful about our alleged, dangerous incompetence, demanded that they refer us to the GMC, as is their professional duty.
They chose not to refer us.
Readers may draw their own conclusions.
All that is left to denigrators is to repeat the Big Lie, that there is no evidence for the effectiveness of homeopathy.
Interested readers should seek out the evidence (3,4) themselves.
Readers should not expect help from the BMJ.
The BMJ is busy, lecturing Big Pharma, on the need to be more honest.
1 BMJ 2015;351:h4797
2 Wm Keegan, The Guardian, www.theguardian.com/business/2015/jun/14/george-osborne-big-lie-economy-...
Competing interests: peripatetic homeopath
As a doctor, the dismissal of a patient’s legal challenge to NHS Lothian’s decision to cease providing homeopathy saddens me greatly. We certainly have arrived at a sorry state when a frail 74-year-old woman suffering from a painful chronic condition has to resort to the courts to try to get a relatively inexpensive treatment that she and her doctor have found to be beneficial to her health. The judge’s ruling makes a mockery of the government’s avowed intention of putting the patient at the centre of the health service and its policy of creating more patient choice. That a health board believes spending thousands of pounds in legal fees to deprive patients of services is money well spent – instead of using the money to pay for services – beggars belief! This ruling will disappoint all those who are passionate about patient choice; but, I fear, their disappointment will be nothing compared with that of the elderly patient who has seen her final hope of getting the NHS treatment she needs dashed.
Competing interests: President of the Faculty of Homoepathy