Last night I attended a splendid talk by one of Britain’s most famous homeopathic veterinary surgeons, Chris Day. It was most inspiring to hear about this gentleman’s career in veterinary medicine and the huge part that homeopathy  has played in his many decades of practice.

For many people, the fact that homeopathy appears to work on animals, is all the evidence they need. I guess some of our critics will disparagingly say this is also the placebo effect because somehow a dog or cat ‘picks up’ the enthusiasm of the homeopathic vet and its owner. Even if it did work that way, it would be pretty miraculous. But what about a cow? Are cows with mastitis also susceptible to suggestion? Or is it the homeopathic remedy in the drinking trough that protected the herd that drank from that trough – but not the cows that were randomly selected to drink from another trough.

Chris Day has many devoted farmers as clients. For professional farmers the bottom line has to be money – so it just would not be cost-effective for them to employ homeopathic veterinary services unless the results were really good. I was amazed to hear Chris say that he went a whole year once without prescribing a single antibiotic! There is huge concern about the overuse of antibiotics on farm animals these days, so this is an incredible achievement.

For the Disciples of Scientism, I am naïve, less-than-scientific and believe that medicines with ‘nothing in them’ can help humans as well as animals. But hey, I’m not the only one. The EU recently voted to spend £1.8 million (sic) on research into the treatment of farm animals with homeopathy. This has to be the right and ethical approach. If critics of human homeopathy think it’s all placebo, they should be very enthusiastic about preserving NHS institutions that get people better just by talking to them as such places are – at the very least – a valuable teaching resource for all doctors and medical students. They should also keep an eye on those cows doing well on homeopathic medicines!

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How beauteous mankind is! O brave new world,

That has such people in’t!

(The Tempest Act 5 Scene 1)

Shakespeare’s irony did not escape the novelist Aldous Huxley. His 1932 novel, Brave New World, takes place around the year 2500. The people are oppressed by ruthless authorities, distracted by inane televisual ‘entertainment’, controlled by genetic and social engineering and numbed into conformity by a tranquilising drug called ‘soma’.

Brave New World (1932) preceded the more famous but similar  novel, 1984, written by George Orwell in 1949. The contemporary world seems to be approaching these novelists’ apocalyptic vision with alarming speed. As a doctor, I am most concerned by the exponential increase in the prescription of antidepressants and tranquilisers – especially during the present recession. The Guardian reports that the prescription of antidepressants has increased by 20% in just three years.

This is particularly outrageous because two years ago a major study warned that antidepressants were no better than placebo in mild and moderate depression (surely the majority of cases) as I mentioned in a post at the time. My point was that it was the height of hypocrisy to criticise NHS homeopathy (drug budget £10 million) when the budget for these less-than-evidence-based antidepressants was £232 million!

At the time, the medical profession vowed to ‘do something’ about it. What has been ‘done’ is that the prescription of antidepressants in the UK has – in the words of the Guardian – soared. The situation across the Atlantic in the USA which offers the best medicine money can buy – is even worse. The use of anti-depressants in the ‘home of the brave’ has in the words of USA Today ‘skyrocketed’ by 400% (sic!) since 1988.

The situation with highly addictive tranquilising drugs is another horror story that I’ll leave to somebody else to write about. Both sets of drugs have potentially dangerous side effects and patients really should be monitored carefully on them – if their doctors can find the time of course. But it seems nobody cares that much about these horrific statistics. After all should we really be knocking such a profitable industry during a recession? Much better to start a new organisation protesting against all that money wasted on treating naive patients who want NHS homeopathy. And don’t read Huxley’s Brave New World either – read his last novel, Island. It’s about a type of Utopia and much more optimistic than Brave New World.

Stay optimistic and banish your fears

Orwell was out by at least forty years.

(from Instructions for Androids)

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I have read the discussion in the Comments section of my last post and realised that in the realm of political philosophy there are two basic schools of thought on the issue of NHS Homeopathy:

The Libertarian Position

1.   Homeopathy should remain available on the NHS as long as there are NHS GPs who are willing to refer patients to other fully accountable, medically qualified doctors specialising in homeopathy.

2.   GPs (and perhaps local health authorities) are in the best position to decide whether their patients get NHS homeopathy (and any other form of complementary medicine) however it works and however others may interpret the data from various meta-analyses.

3.   Evidence based Medicine is important, but if it is to be used as a litmus test for inclusion of any intervention on the NHS, then a specific level of evidence must be set and applied across the board to all medical interventions seeking inclusion on the NHS.

4.   Science, no matter how logical, right, correct and rational it thinks it is, should never be allowed to trump the democratic process.

5.   There is much more at stake in this issue than homeopathy. Patient choice and doctor choice are vital to the preservation of a liberal democracy.

The Authoritarian Position

1.   Homeopathy should be centrally removed from the NHS. GPs who wish to refer patients for NHS homeopathy should be legally thwarted from doing so – for the good of their patients.

2.   Non-doctors, academics, physicists, biologists, journalists and bloggers are just as qualified as any GP to decide whether his/her patient should be referred for homeopathy. Homeopathy does not work so it’s clear to all laymen and journalists that GPs should not be allowed to refer patients for NHS homeopathy.

3.   We now live in an evidence based society. Homeopathy is both implausible and proven (by meta-analysis) not to be evidence-based. Thus it should not be available on the NHS. Other non-evidence based NHS approved interventions are more acceptable because at least they are not as ridiculously implausible as homeopathy.

4.   Medicine must be based on science and nothing else. The obviously deluded minority of patients and doctors who want homeopathy in spite of it being obviously non-scientific, must be prevented by central Government from getting it on the NHS.

5.   This is all about society ridding itself of deception, and non-scientific rubbish like homeopathy and nothing to do with liberty, democracy and patient choice.

My position is clear: I strongly favour the Libertarian Position on this issue.

So did Mike O’ Brien, Minister of Health of the last Labour Government.

So did Anne Milton, Minister of Health of the present Coalition Government.

As the Head of State is known to use homeopathy and retain a Royal homeopathic physician, it would be reasonable politely to assume that she also favours this position.

If I have not represented the Authoritarian Position clearly, I am happy to accept suggested edits from those supporting that particular political philosophical position in relation to this issue

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The denialists, detractors and critics of homeopathy were back in action this week.  In a critical letter to the BMJ protesting against the Government seeking advice (sic) from experts on the registration of homeopathic products. Referring to homeopathy as ‘naked quackery’ and ‘pseudoscience’, the letter was written by Susan Bewley (an obstetrician) ‘on behalf’ of a list of names including the usual suspects, Ernst, Baum, Rose etc.) It seems the letter section of the BMJ has become a popular forum for these doctors to spout their vituperative, amateur homilies on medical politics.

So let us look at the history of the politics of homeopathy in the UK. It is important to acknowledge that throughout its history homeopathy has been attacked for the same reasons: Dilutions, implausibility, quackery and now ‘pseudoscience’, ‘bad science’ etc.

19^th Century: Dr F. Quin studies homeopathy in Germany, brings it to the UK, treats the Prince of Wales and builds the London Homeopathic Hospital.  Several other homeopathic hospitals are built in England and Scotland.

1948: The NHS is formed and all the homeopathic hospitals are INVITED to become part of it. This is the reason why homeopathy (unlike aother forms of CAM) is so strongly integrated into the NHS. Homeopathic doctors and their benefactors had built hospitals staffed by doctors specialising in homeopathic treatment prior to the formation of the NHS.

1948-1990: Homeopathy becomes more and more popular both on the NHS and in private medicine. However the opposition movement becomes more determined to end NHS homeopathy. They attack on two main fronts: PR & Media and direct political attack. On the media front, The Guardian newspaper and the supposedly neutral BBC prove to be particularly useful allies to their cause but in the realm of official politics they suffer serious defeats.

December 2009 Political Defeat I: The denialists manage to get a Science and Technology Subcommittee to do an ‘Evidence Check’ on homeopathy. The findings of these controversial hearings is voted on by only 4MPs of a possible 12-13 and only 2 of those 4 actually attended the hearings!  Mike O’Brien, the then Minister of Health in the Labour government speaks at the hearings. He famously describes the draconian anti-homeopathic suggestions of the Committee as ‘illiberal’ and makes it clear that GPs and local health authorities are best placed to decide if their patients should get NHS homeopathy or not.

July 2010: Political Defeat II: The report (with its authoritarian anti-homeopathic and anti-democratic  recommendations) passes to the new Coalition Government for consideration. The new Health Minister, Anne Milton thanks the S&T Committee for their work but then kicks all their recommendations into touch. Her reasons for doing so are much the same as the Labour minister’s: GPs and local health authorities should be trusted to make the best decisions for their patients. An infuriated Michael Baum pours scorn on her in a well-publicised letter to the Lancet concluding with a condescending “Shame on you Minister!”  I was personally astonished by the aggressive, rant-like nature of this letter as Baum had only a few months before called for the debate on homeopathy to return to the ‘realm of polite disputation’.

So summing up:

Government under Labour: supported homeopathy on the NHS.

Government under Coalition: reiterated this support almost to the letter.

Head of State and family: are known to use and have used homeopathy for several generations.

The detractors, denialists and illiberal, wannabe Statist authoritarians  have tried to thwart GPs (rather than dissuade them which would at least be respectable) from referring patients for NHS homeopathy by insisting that their scientism trump due democratic process – but it hasn’t worked. Despite what Ben Goldacre writes in the Guardian, despite the letters to BMJ and Lancet, and despite inexplicable and inexcusable BBC bias against homeopathy, both Labour and Coalition Governments have seen fit to protect the significant minority support for homeopathy in the UK as well as the rights of British GPs to send their own patients for NHS homeopathy if they so wish. In doing so Government has so far managed to resist a serious, concerted attempt to undermine the democratic provision of health care in this country.

The attack on homeopathy has been a veritable Pandora’s Box of vitriol and bias that has certainly damaged British homeopathy by it’s sheer persistence and seemingly well-funded mass pressure at a PR level. It is heartening to know that at least at a pure political level, there has been unequivocal support by both Labour and the Coalition not only for homeopathy, but for something equally as important –  liberal democracy itself. Fortunately the last thing to come out of this particular Pandora’s Box was still Hope.

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I have just completed a lecture tour of major homeopathic institutions in India and have been blown away by the enthusiasm of teachers, homeopathic doctors and students. In Pune my lecture was supported by the orthodox medical faculty as well as the faculty of homeopathy and I chatted to a medical doctor trained in homeopathy in London (Dr Anil Habbu) who has treated an estimated 500 000 patients (sic) with homeopathy so far in his career.  In Jaipur I lectured at a university exclusively dedicated to teaching homeopathy. I was taken on a tour of BJain Pharmaceutical plant and can verify that the standard of manufacture there is as good as any I have ever seen anywhere in the world.

With the West heavily in debt it is only a matter of time before the East (esp. China and India) become part of the new world order. Nothing can stop the proliferation of homeopathy in India and the relentless attacks  of homeopathy’s denialists and detractors – whom I’ve dubbed the Disciples of Scientism – mean nothing in a country of over 1.2 billion people. Although the BBC and some of the British media favour their deterministic and often anti-democratic view of medical care, homeopathy continues to grow internationally. So far the views of the Disciples of Scientism (although given FAR too much space in the media) have not been able to trump democracy.

You can only get NHS homeopathy in the UK if you are referred to an NHS clinic by your GP. But that does not satisfy the Disciples of Scientism and today there is another inane poll in The Guardian on this very issue. Someone needs to tell these guys that once upon a time the British were considered to be good losers.

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My book The Homeopathic Conversation has been republished in India and I am most honoured to be invited to give a lecture tour of India in August.

While homeopathy has been vituperatively insulted, attacked and demonised by various groups in the UK (which thankfully do not include this Government, the last one or the head of State) it has always had a prominent and respected place in the medicine of the world’s biggest democracy – India. On doing a little research into Indian homeopathy I was absolutely flabbergasted by the sheer scale of homeopathy in India.

I am most grateful to my colleague, Dr Manish Bhatia for much of the following information about Indian homeopathy:

Number of homeopaths in India:

Official Government figure: 350 000 (sic) homeopaths

Unofficial figure (includes unregistered, registration expired and lay homeopaths)

500 000 (that’s half a million!)

Indian Government attitude to Homeopathy:

• Indian Government ‘VERY supportive’ (Dr Bhatia) to homeopathy.
• Government even runs TV commercials to promote homeopathy!
• There are 1000s of Government homeopathic dispensaries and OPDs (outpatient departments) in India
• There are 176 Homeopathic Colleges in India of which 35 are Government run.
• There is a government ministry (AYUSH) dedicated to alternative medicine (including homeopathy) in India.

Regulation:

Homeopathy is fully regulated in India by the Central Council of Homeopathy (CCH)  and Central Council for Research in Homeopathy (CCRH).

Conclusions: It seems clear that homeopathy is there to stay in India. So next time you see or read some condescending and patronising rubbish about homeopathy in the media, know that in India, a country with a population of 1.2 billion people (that’s more than 20x the population of the UK) homeopathy is an integral part of the healthcare system and deeply respected by the people of that country.

The word on the street is that India and China will be important parts of the emerging new world order so watch this space for an article on the place of Traditional Chinese Medicine (TCM) in China, a country with a mere 1.3 billion people.

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Once again a major politician has said something good about homeopathy – and this time it was the Prime Minister, the right honourable David Cameron himself. In defence of his NHS reforms on Channel 4, the main man said: ‘I’m going to sound like a homeopath but this is like looking at the whole of the patient.’ Well I don’t know how much the top dog in the country knows about homeopathy but he seems to understand that classical homeopathy does try to treat the whole person by trying to use a medicine to stimulate the body to heal itself. Nice one, Dave!

It’s interesting to reflect that when a major politician has something to say about homeopathy, it is usually positive or supportive of it remaining on the NHS.

Mike O’Brien: Labour’s Minister of Health (Feb 2010) ‘We take the view that it is not our job to stop clinicians prescribing these medications if they feel they are appropriate.’ 

Anne Milton: Coalition Minister of Health (July 2010) ‘The Government … remains of the view that the local National Health Service and clinicians are best placed to make decisions on what treatment is appropriate for their patients’ – as she kicked into touch recommendations to scrap NHS homeopathy.

The Queen: Well the Queen has not said anything and we don’t expect anything. Nevertheless it is well known that the Royal Family appoints a Royal homeopathic doctor and has supported homeopathy since the early 19^th Century.

I find it interesting indeed that although major politicians and the head of state clearly do not support the current assault on homeopathy and CAM by the sceptics, the media are only too keen to put the boot in and seldom allow homeopaths a level playing field to defend what they do.

From Great Britain to Sad Britain Meantime Great Britain seems to have become Sad Britain, as the prescription of anti-depressants has hit an all time high. Actually in spite of a huge NHS bill for these drugs alone (it dwarfs the bill for NHS homeopathic prescriptions by at least 20 to 1) there is little evidence that they are much better than placebo for mild and moderate cases of depression – and that does mean the majority of cases of depression. A major study showed that most prescribed anti-depressants are no better than placebo for most cases of depression – but you don’t see much about that in the media. It’s a pity that these drugs don’t work on the managed depression of the Economy (aka ‘The Recession’)  either.  I’m starting to think of Aldous Huxley and Soma now – but I digress…

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The Government’s chief scientific adviser, Sir John Beddington said this week that ‘patients might believe that homeopathic treatments could protect them against serious illnesses, or treat existing conditions, because GPs and hospitals are allowed to prescribe them on the NHS.’

Does this really constitute scientific advice? Is it appropriate to make such an authoritarian comment after this issue has been fully debated in Parliament and two successive Governments have given considerable thought to this issue and then expressed very different views to his about NHS homeopathy:

Labour Minister of Health, Mike O’Brien: (Dec 1, 2009) “We take the view that it is not our job to stop clinicians prescribing these medications if they feel they are appropriate… cutting the (NHS) funding would be “illiberal” and “a denial of personal choice”

Coalition Minister of Health, Anne Milton: (July 26, 2010 – the official government decision on the issue) Homeopathy has a “long tradition… and that local National Health Service and clinicians are best placed to make decisions on what treatment is appropriate for their patients”.

Sir John Beddington is not a medical doctor. He is however an internationally renowned specialist in the economics and biology of sustainable management of renewable resources and has previously advised UK ministers on scientific and environmental issues. May I humbly suggest that instead of insulting GPs who choose to send their patients for homeopathic treatment with the full support of this government and the last, he pays some attention to the connection between his specialist field, the environment, and homeopathic medicine.

I recommend he google the words: ‘Sustainability’ ‘Homeopathy’ ‘Environment’. In an excellent article on this, Joel Kreisberg, writes: “In ecological terms, homeopathic remedies never exhaust natural resources; there is negligible environmental impact and no question of over-consumption. Remedies meet the criteria for both renewable and sustainable sources of medicine. Compared to the waste stream produced by pharmacological manufacturing and by hospitals, the waste produced by a homeopathic pharmacy is infinitely small. No waste is produced from the original material; it is all used. And no harmful chemicals or complex reagents are used in the manufacturing process.”

I do not wish to denigrate pharmaceuticals, many of which have tremendous value in medicine. But homeopathy has value too and is clearly also very, very environment friendly.

Ed and Liz discuss this in Episode 3.

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The Debating Society of University College London met last night. The motion was: This House would stop the funding of homeopathy on the NHS.

The result was close but a heart-warming win for the supporters of NHS homeopathy.

For the Motion: 71
Against the Motion: 78
Abstentions: 41

This was most heartening as there were very few outside people present. The room was packed with students and the atmosphere was lively.

Some of you might remember the last time UCL debated this topic. That was two years ago, when the result went against the provision of NHS homeopathy. You can see my report on that debate here.

The only survivor from the first debate was Prof. David Colquhoun who gave his boiler plate speech about the implausibility of homeopathy while having little to say about freedom of choice and democracy. Clare Stanford, opposing him, seemed to agree that homeopathy might be placebo (sic), but argued that it should still be on the NHS. I managed to speak from the floor and get a few words in about liberty, democracy, and freedom of choice for patients and GPs.

It’s hard to say if this signifies that the tide is turning towards homeopathy but at least the students of UCL did not vote for a Soviet Union style motion emphasizing the need for State control and coercion of doctors. As I’ve always said: You can only get to see a doctor on the NHS if your GP refers you. We don’t need diktats from Westminster restricting and thwarting the clinical judgement of our NHS GPs, thank you very much. So well done UCL!

Episode 2: Scientism with Liz and Ed.

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The New York Times published an excellent article on how doctors have neglected learning or practising one of the most important aspects of their art – the physical examination.

The fact that many doctors order sophisticated tests without examining their patients properly is no less than a tragedy for medicine. There will never be any machine that can diagnose as accurately as a human being trained to be a doctor.

When I was at medical school in the late 70s, we were taught that you should make about 70% of your diagnoses from talking to the patient alone. Another 20% can be made from your physical examination. Sophisticated tests could pick up another 5-10% but they were mainly there to confirm what one already thought was wrong with the patient.

Things might have changed a little since then – not because the art of talking to patients and the art of examining patients have changed that much in the last 30 years – but because tests and technology have become more sophisticated. However there can be no excuse for refraining to examine our patients and there are many vital signs that can be detected by a doctor at the bedside that are invisible to the most expensive of medical investigative machines. I was taught in no uncertain terms that: ‘If you don’t put your finger in, you put your foot in!’ and the great physician, Professor Harry Seftel advised me to ‘wallow in the secretions’ of my patients.

Let us never abdicate the responsibility of diagnosis to machines. Machines are there to help doctors – not the other way around.

Event: There will be a debate at UCL on Monday night(25th October) on This House Would Stop Funding Homeopathy on the NHS This is the second one they have had on exactly this subject. Details can be seen here. The speakers announced are both pharmocologists. Am I alone in thinking it odd that a clearly political debate will be discussed by pharmocologists? If UCL debated: This House Would Abolish The Royal Family, would it be appropriate to have two professors of genetics arguing whether the superiority of the Royal chromosomes justify the amount of taxpayers’ money spent on the Royal Family? To be fair, I was invited to speak at this debate (with 4 days notice!) but was advised to decline on this occasion because of the ridiculously short notice given to me. I’ll come along anyway though and perhaps say something from the floor if invited to do so. Why not come along yourself and watch how pharmacologists debate an issue that is essentially about liberty and democracy?

Meanwhile Ed and Liz continue their conversation about Homeopathy, the NHS, Science, Scientism and Democracy.

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