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The Pie Man is Corrected!

Critics of homeopathy (and CAM) repeat endlessly there is ‘no evidence’ that they work beyond placebo and therefore homeopathy should not be funded by the NHS.

This disingenuously gives the entirely false impression to the public that all NHS-funded medical interventions are obviously evidence based. This is not only false, buy it is light years from the truth.

The Pie Man exists to remind critics of homeopathy and CAM that most interventions employed by doctors (on the NHS and elsewhere) are certainly not evidence-based. As always I defer to the British Medical Journal’s highly-esteemed handbook called Clinical Evidence.

The reason I’m writing about the Pie Man today is that the figures have changed. Unfortunately for people like Edzard Ernst, cialis Michael Baum, prescription Simon Singh, Ben Goldacre et al, that use EBM (evidence based medicine) as a tool to attack homeopathy and CAM exclusively, the case for orthodox medicine being evidence-based just got a whole lot worse.

Here is the Pie Man as first published a year ago.

Critics of homeopathy (and CAM) repeat endlessly there is ‘no evidence’ that they work beyond placebo and therefore homeopathy should not be funded by the NHS.

This disingenuously gives the entirely false impression to the public that all NHS-funded medical interventions are obviously evidence based. This is not only false, it is light years from the truth.

The Pie Man exists to remind critics of homeopathy and CAM that most interventions employed by doctors (on the NHS and elsewhere) are certainly not evidence-based. As always I defer to the British Medical Journal’s highly-esteemed handbook called Clinical Evidence.

The reason I’m writing about the Pie Man today is that the figures have changed. Unfortunately for people like Edzard Ernst, Michael Baum, Simon Singh, Ben Goldacre et al, that use EBM (evidence based medicine) as a tool to attack homeopathy and CAM exclusively, the case for orthodox medicine being evidence-based just got a whole lot worse.

Here are the the latest figures from Clinical Evidence which makes the Pie Man look like this:

And here are a comparison of those figures

Proportions of Commonly-used Treatments supported by Good Evidence

March 2009 Today

Beneficial 13% 11%
Likely to be beneficial 23% 23%
Trade off between benefits and harm 8% 7%
Unlikely to be beneficial 6% 5%
Likely to be ineffective or harmful 4% 3%
Unknown effectiveness 46% 51%

This means the big loser in recent changes are treatments proven to be incontrovertibly beneficial (15% loss of its share) and the big winner was ‘Unknown effectiveness’ (gain of nearly 10%).

So next time you hear a doctor criticise homeopathy for lacking evidence, know that s/he is a doctor in a glass house throwing stones and ask him or her quietly what % of conventional interventions on the NHS are fully evidence based.

By | 2010-06-06T17:42:03+01:00 June 6th, 2010|Homeopathy, The Pie Man Strikes!|46 Comments

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46 Comments

  1. Simon Singh June 13, 2010 at 9:29 am

    Hello Brian,

    If your readers want to have a balanced view of the issue, then they may like to look at the exchanges that took place when you raised this issue in PULSE (please see comments by by Brian Kaplan and Les Rose)http://www.pulsetoday.co.uk/story.asp?storycode=4124825

    Also, this website presents a very different view to your own http://www.veterinarywatch.com/CTiM.htm – “Thus, published results show an average of 37.02% of interventions are supported by RCT (median = 38%). They show an average of 76% of interventions are supported by some form of compelling evidence (median = 78%).”

    Mainstream medicine still has a long way to go, but (in my opinion) the picture is nowhere near as bleak as it appears in your blog.

    • Dr. Kaplan June 13, 2010 at 1:38 pm

      Hello Simon,

      On my exchange with Les Rose on Pulse: I would be more than happy for anyone to look at that exchange and would debate this issue in public with Les Rose, yourself, David Colquhoun, Michael Baum and of course the erstwhile Edzard Ernst anytime and anywhere.

      What do you mean by ‘your own view’? I cite the BMJ’s handbook on Clinical Evidence on the evidence for medical interventions. Sure the book includes a miniscule amount of well-known alternatives such as milk thistle in the interventions analysed but the huge majority of interventions analysed in it are purely conventional.

      You say: ‘nowhere near as bleak as it appears in your blog’. Okay Simon, you are a scientist, so please give your interpretation of the pie in Clinical Evidence. Tell me what I’m missing there please.

      You seem to miss or choose to miss the whole point of my argument which is as follows: Conventional medicine is very far from being fully evidence based and the NHS has not decided to remove interventions that are not evidence based from what it offers to the public. Thus it is hypocritical and disingenuous for opponents of CAM to call for homeopathy for example to be removed from the NHS for ‘lack of evidence’. Why is this disingenuous? Because it leaves in the public’s mind the very false message that conventional medicine is obviously all evidence-based.

      You say “some sort of compelling evidence” Well I say a 70% patient satisfaction rate of patients at the Bristol NHS homeopathic hospital for patients who were not helped by conventional medicine is ‘some sort of compelling evidence’ that NHS homeopathic hospitals are cost-effective health resources very much appreciated by the public however anybody thinks homeopathy works. Your co-author, Prof Ernst tried to wriggle out of this one by saying that the doctors there also sometimes use conventional medicine. Of course we do! We are doctors and choose what’s best for our patients depending on the situation.

      I look forward to seeing your scientific and objective analysis of the BMJ pie chart that seems to be such a thorn in the flesh of those who would seek to delegitimise homeopathy in the UK. http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

  2. Simon Singh June 13, 2010 at 1:48 pm

    Hello Brian,

    I deliberately gave a short response, because I just wanted to point your readers towards a different set of views. Again, I would encourage readers to look at
    http://www.veterinarywatch.com/CTiM.htm

    Previously I have found that discussions with you have taken up a huge amount of time and have not been very productive. Moreover, in the wake of my legal case, I have a massive backlog of work and family life that I need to focus on. So I will not comment any further.

    However, I do have a suggestion. You could write to a journal (e.g., FACT) and ask Edzard or Les Rose if they will engage in a 1 page debate on the evidence for conventional medicine versus homeopathy.

    • Dr. Kaplan June 13, 2010 at 2:26 pm

      Hi Simon,

      I’m sorry that I apparently have wasted so much of your precious time but may I remind you that it was you who put a comment on my website which I simply replied to. May I wish you a happy family life and a speedy cleanup of any legal debris remaining.

      I’ve made myself available for debate in papers, magazines, in public, on the net and on the beaches on this issue. Nobody has ever refuted my central assertion which is as follows:

      As far as the NHS is concerned: Either use EBM as a litmus test for inclusion on a level playing field for all interventions OR trust in qualified doctors to make informed and responsible decisions wrt their patients being seen by qualified doctors practising homeopathy on the NHS.
      To use EBM as Ernst, Colquhoun, Goldacre, Rose and yourself among many others have done, as a weapon against CAM exclusively (when clearly much of NHS orthodox medicine is not backed by evidence) is disingenous in my opinion.

  3. Dr Aust (PhD, not medical) June 13, 2010 at 6:18 pm

    Dr K

    That last part of your argument completely ignores the prior probability problem, which has been exhaustively discussed by the folks over at Science-Based Medicine, e.g. here.

    “[We have discussed in a previous post why] Evidence-Based Medicine (EBM) is not up to the task of evaluating highly implausible claims. That discussion made the point that EBM favors equivocal clinical trial data over basic science, even if the latter is both firmly established and refutes the clinical claim. It suggested that this failure in calculus is not an indictment of EBM’s originators, but rather was an understandable lapse on their part: it never occurred to them, even as recently as 1990, that EBM would soon be asked to judge contests pitting low powered, bias-prone clinical investigations and reviews against facts of nature elucidated by voluminous and rigorous experimentation. Thus although EBM correctly recognizes that basic science is an insufficient basis for determining the safety and effectiveness of a new medical treatment, it overlooks its necessary place in that exercise.

    .

    Secondly, the obvious problem with your:

    “trust in qualified doctors to make informed and responsible decisions wrt their patients [e.g. as seen with] qualified doctors practising homeopathy on the NHS”

    – is that it ignores the ethical problems of therapies which have been quite clearly shown not to be “what they say on the tin”. I think there are real problems with sending people away with the impression that Magic Beans / homeopathic remedies are the things effecting any subjective improvement in their condition. The Journal of Medical Ethics seems to be rather doubtful too.

    • Dr. Kaplan June 13, 2010 at 11:03 pm

      Dear Dr Aust,

      Many thanks for your thoughtful and intelligent critique. I really mean that as I’ve had to deal with so many jeering and insulting comments since I began defending homeopathy – which incidentally is just one of four major tools that I use in my whole person orientated practice which of course includes orthodox medicine.

      The essence of my position here is essentially political. We have in the UK a single system of universal health care. Within that system are a few homeopathic hospitals staffed by fully qualified doctors who accept referrals from NHS GPs to them of patients who studies show, clearly benefit from those consultations, having previously not being helped by conventional medicine. Many come from families who have used homeopathy for a long time – as has the Royal Family. What Ernst, Goldacre, Baum, Colquhoun and others want to do is thwart the wishes of the GPs who want to refer patients for homeopathy on the NHS and I find this deeply objectionable. I also personally find it distasteful and perhaps somewhat intellectually dishonest how they misuse EBM to attack homeopathy while ignoring the fact that much of conventional medicine fails the ‘EBM Test’ http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp Just look at the whole discipline of psychiatry for starters in particular the use of anti-depressants in mild and moderate depression. http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045

      Addressing your final paragraph: I agree that medicines that claim to do something specific and have clearly been shown not to do ‘what they say on the tin’, is controversial. This would apply to OTC homeopathic medicines that claim to cure specific problems – a very different issue from patients seeing qualified homeopathic doctors on the NHS.

      An intelligent response to the whole homeopathy on the NHS question would imo be to study and interview in detail the patients attending homeopathic hospitals. Something happens to make them better and those who don’t think it’s the homeopathic pills should have the natural curiosity of the moral and caring medical scientist to find out what that ‘something’ is. Unfortunately it has been their custom to adopt an arrogantly scientistic attitude and choose to jeer and smear homeopathic doctors instead. In my opinion this is a clear case of contravening the important Hippocratic dictum: Primum non nocere.

      Thank you for your comments. I would actually enjoy debating the issue of NHS homeopathy with you whatever our difference in philosophical standpoint.

  4. Andrew Sikorski June 18, 2010 at 2:55 pm

    Apparently family members of some of the most vociferous critics of homeopathy have used homeopathy with benefit.

    Again the question of why dumb animals might improve with homeopathic treatment remains ignored.

    Why should professors addicted to pipe smoking, who manifestly blow smoke in the face of medical research and epidemiological data on health behaviour be taken seriously?

    Finally calling homeopathy witchcraft is tantamount to religious affrontery as Wicca is apparently a recognised religion in this country and does not include homeopathy.

  5. Sastry.M June 19, 2010 at 10:40 am

    Full agreement with Andrew’s comments.
    HOMEOPATHY IS THE ONLY RELIGION Science has ever offered to Humanity.Religion appeals to individual choice and faith in precepts.REF:Miracles of Healing by J Ellis Barker-Homoeopathic Publishing Co Ltd, Hanover Square.LONDON, W.1
    First edition.1931, reprinted 1948.
    Dumb animals are created with definitive ROMs characteristic of each species with a limited random access of improvisation using human domestication as well as will to survive with temporal changes. Human efficiency is summarily sized to 50% by virtue of choice of random accessing as well as definitive choosing between two probable options and further depreciated with personal inconsistencies.Even the fastest human will be slower than a biggest animal like rhino or elephant in a sprint of run and the best silk threads are small in comparison with that of a tiny spider. Hence homeo medicines proved painstakingly on the least efficient human system act with best advantage in veterinary practice as clinically reported.
    The founder Dr.Samuel Hahnemann himself was a cigar addict and being questioned why he replied that cigars have remained his lonely companion giving solace in his poverty and kept his innovative zeal burning.
    If religion appeals to humility and service to humanity with devotion it the virtue of human individual but if it appears as witchcraft to some one it betrays the same with a negative sign.

  6. Dr Amit Habbu June 19, 2010 at 3:11 pm

    I am not sure homeopathic medicines are more effective in veterinary practice, as many of the best cures are when remedies are selected on the basis of the mental make up of the individual — the mind and emotions subsection of the repertory. This obviously is not possible with animals, or at least definitely not with the same confidence. Veterinary prescriptions are extrapolations at best and to my mind can never ever be as accurate as for humans.

  7. MD Renate Groetsch July 13, 2010 at 11:16 pm

    Hello Brian, thank you for your detailed work against the critics of homoeopathy in the U.K.
    Since yesterday, it seems that the same problem started in germany too. There was an article in the well-known paper “Der Spiegel”. Dr. Lauterbach, a politican of the socialistic party SPD pointed out that homoeopathy is only placebo, that there is no scientific proof an therefore homoeopathiy treatment shouldn´t be payed by the insurances.The same arguments I heared from the U.K., the same way to attack us, the same hand-writing…
    So your pie-man will help us a lot to defend us against these so-called scientific EBM-people . Thanks a lot!!!

    • Dr. Kaplan July 14, 2010 at 5:13 am

      Thanks Renate,
      Yes, definitely use the Pie Man to make the point that large segments of conventional medicine are not evidence-based and don’t get caught up in their game of ‘orthodox medicine as a whole is more evidence-based than homeopathy’. Either insurances pay for only evidence-based interventions or they do not. The last thing conventional doctors, chemists and manufacturers want is to have all their non-evidence based drugs and interventions not funded by insurance companies.

  8. Dr Amit Habbu July 15, 2010 at 11:10 am

    Why is homoeopathic treatment so expensive in Europe that people have all these considerations about NHS/Insurance ?

    • Dr. Kaplan July 15, 2010 at 8:51 pm

      Good question. The fact is people pay a tax called National Insurance which pays for the NHS. So those who want to be treated by homeopathic doctors (as they have been for some time) on the NHS, want this to continue.

  9. Dr Amit Habbu July 16, 2010 at 5:22 am

    Hello Dr Kaplan. I am aware of this tax and also that people do want the same to take care of their homoeopathy bills. But if the same doctors ( or others of similar caliber ) charge really “reasonable fees” ( and have a high patient volume low charge kind of an outpatient structure ) in private consultation then perhaps it would help offset the danger of homoeopathy not being on the NHS. That we should fight it not to be struck off the NHS is a separate and legitimate matter of course. By the way how much of Homoeopathic treatment in Britain is on the NHS and how much by way of private practice ?

    • Dr. Kaplan July 16, 2010 at 10:21 am

      Homeopathic doctors in the UK in private practice generally charge a lot less per hour for their services compared to conventional private doctors. They have to pay the same rent, insurance, registration fees etc. I would guess that there is more NHS medical homeopathy than private medical homeopathy but the big sector is private non-medical homeopathy which is a different issue altogether.

  10. Dr Amit Habbu July 16, 2010 at 11:54 am

    They may be charging less per hour, but how many patients would a conventional private doctor see in the time that a homeopath sees one ?

    • Dr. Kaplan July 16, 2010 at 1:54 pm

      Private Homeopathic doctor: first visit 1 hour follow up half an hour (average)
      Private conventional doctor: 15 – 20 minutes all visits. Much more an hour for ‘procedures’ of course
      NHS conventional GP: 7 minutes a patient.

  11. Dr Amit Habbu July 16, 2010 at 2:31 pm

    I think thats where the patient’s cost for private homeopathic consultation goes up. My point is that if you are able to significantly reverse the trend of medical homeopathy being more often sought on the NHS than off it, all these discussions will be redundant and the NHS would probably encourage homeopathy to continue because a much bigger population of patients would seek this therapeutic system. I still maintain that the biggest bane of homeopathy is that the practitioners take too long to make successful prescriptions which thereby limits the number of patients treated which in turn impedes a bigger public opinion from developing.

    • Dr. Kaplan July 16, 2010 at 2:47 pm

      It’s a good point. Don’t forget that most non-medical homeopaths spend a lot of time with patients and don’t charge a lot at all.

  12. Dr Amit Habbu July 16, 2010 at 6:40 pm

    Well if you can’t keep a patient happy with a successful prescription perhaps you have to do so by other means like talking a lot and being extra nice. I really do think the indian model works very well where you end up treating say 60 out of 100 patients successfully rather than 8 out of 10. This way homeopathy will never die irrespective of what the “scientism” brigade and those with vested interests will attempt.

  13. Dr Amit Habbu July 16, 2010 at 7:12 pm

    Well, before anybody misunderstands, i do not mean to say that non medically qualified homeopaths cant make successful prescriptions hence spend a lot of time with patients. This is a statement thats true for any doctor/homeopath. Personally my experience is that if I cant see the remedy in the first 15 mins for a new case then i am unlikely to see it even if i spend another couple of hours. Hence i prefer to make a bonafide prescription at the end of 15 mins and move on.

    • Dr. Kaplan July 16, 2010 at 7:29 pm

      I agree that the Indian model really disproves the UK critic’s argument that homeopathy works by placebo generated by the extra time given to the patient and wonderful bedside manner of homeopaths. However the public here obviously have different expectations of what happens when you see an homeopathic doctor here. They expect to be listened to carefully and given as much time as they think they need. It’s not easy to change this.

  14. Dr Amit Habbu July 17, 2010 at 5:30 am

    Is it that the patients who seek private medical homeopathy largely belong to the rich class ? Because if this is not so, then i am sure if the homeopath reduced his charges by say half and reduced the time of the interview by half and still gave the same results, would’nt patients be more than happy.

    • Dr. Kaplan July 17, 2010 at 2:33 pm

      You may be right about that. However we do have a NHS here and it’s importatant to keep homeopathy on it. Many people, the rich included, are simply
      used to getting health care ‘for nothing’ (they actually pay for it in National Insurance of course) and expect that to continue. If homeopathy is cut from the NHS,
      this will not be good news for homeopathy in general.

  15. Dr Amit Habbu July 17, 2010 at 3:06 pm

    By all means, the fight to keep homoeopathy on the NHS should continue with all vigour and if we in India can be of help, please do let us know. My point was for homoeopathy in general. It is my opinion that there are not so very many good homeopaths around the world. And if these will see only a handful of patients a day, it will be a big disservice to homeopathy. So the idea is to charge ( for example ) half and seeing double the cases, thereby the lifestyle of the homeopath will also not be disturbed. We simply need more people around the world taking homeopathic treatment and benefiting from it. Period. That is the best way we can buy time for basic research to show us the mechanism of action some day.

  16. Adam August 24, 2010 at 4:05 pm

    I’m really not clear what your point is here.

    I dare say it’s true that many interventions used in the NHS have limited evidence of efficacy. Are you arguing that they should all be no longer funded on the NHS?

    I would have some sympathy with that argument (although of course it’s not quite that simple, as Dr Aust has explained above).

    But if you are going to make that argument, then you would also have to argue not to fund homoeopathic treatments, as I’m pretty sure you won’t find a single one of them among the 11% of treatments with solid evidence of efficacy.

    So, what’s it to be? Are you arguing that homoeopathy should not be funded, or are you arguing that it actually doesn’t matter whether or not treatments have good evidence of efficacy?

  17. Adam August 26, 2010 at 7:55 am

    Thanks for your response, Brian, and in particular for describing my questions as very reasonable, as indeed is your reply. It’s great to talk to a homoeopath in a mature and reasoned manner. Doesn’t always turn out that way in some corners of the internet for some reason, so it’s reassuring to see that it can.

    (Yes, I realise things have moved on quite a bit, but for some reason I’ve only just seen this blog post, and thought it was still worth a reply.)

    OK, I think I understand your main point. You think EBM has too much prominence, and shouldn’t figure nearly as strongly in NHS funding decisions as some say it should, right?

    So, if I’ve understood correctly, you say that SSRIs have a very weak evidence base (and if we’re talking about milder forms of depression, I totally agree with you), but you’re not saying they shouldn’t be available on the NHS? You believe that doctors should be free to prescribe them if they believe them to be helpful, even if they are sometimes wrong to think that: it’s the doctor’s responsibility to take that decision and deal with the consequences if the decision is wrong, not the government’s. Have I understood your point correctly? If so, I’m not sure I agree with you, but would admit that it is a consistent position with at least some degree of legitimacy. The sort of thing where reasonable people can agree to differ.

    However, I do have to take issue with your point 3. I think you may be using a bit of a straw man argument here. You say that homoeopathy’s dectractors want to avoid many non-evidence-based conventional treatments being axed from the NHS. Do they really say that? Who says it? When have they said it? I’m a detractor of homoeopathy (at least mostly, although possibly not in an absolute way, as I do have some sympathy for homoeopathy in one limited way, although that’s kind of irrelevant to the discussion here, so let’s save that for another day), and it’s certainly not an argument I would make. I would absolutely be in favour of treatments that don’t work being removed from NHS funding, no matter what kind of treatments they are. I suspect most other detractors of homoeopathy would think the same, although obviously can’t speak for all of them.

    • Dr. Kaplan August 26, 2010 at 5:36 pm

      Hi Adam,

      Re: SSRIs: Their evidence base is worse than you think. Kirsch et al recommend their use only in the most severe cases of depression and then only when other methods haven’t worked. That would pretty much limit their use to NHS psychiatrists but these medicines are dished out by GPs and I even went to a free seminar for GPs on managing depression in the 10 minute consultation. Needless to say these medicines featured prominently in the ‘management’ recommended. But yes you do understand my point correctly. Responsibility should rest with doctors.

      Re: Point 3: I state unambiguously: It is disingenuous, hypocritical and duplicitous to use the term EBM to attack and exclude from the NHS homeopathy EXCLUSIVELY rather than use it as a test for NHS admittance across the board for ALL medical interventions. I would not have supported a campaign for doctors to be straitjacketed into only using EBM government endorsed interventions but I would not have considered such a campaign to be disingenuous. Where is the Straw Man argument in this?

  18. Andrew August 26, 2010 at 10:05 am

    Hi,

    I’m a little late to this interesting debate, but anyway… I have to agree with Dr Aust above. As I see it, the case against homeopathy isn’t simply that there is no evidence for it – it’s that there is no evidence for it (when, if it worked as Hahnemann described, there would be), *and* there is no basis for it having an effect.

    For example, I was following a discussion between a mother who was convinced homeopathy had cured her son’s asthma and someone who was pointing out that asthma did go into remission sometimes.

    I imagine if someone studied that case and interviewed that mother they’d conclude that she thinks homeopathy works and therefore it should be funded.

    Whereas in actuality it’s just an illustration of someone’s inability to understand that correlation is not necessarily causation. My childhood asthma improved (without homeopathy) around the time I started getting Transformers toys. Should I conclude that Transformers cure asthma? Of course not. Yet that is no more absurd than concluding that magic water cured it.

    The point being, there is a basis for concluding the asthma went into remission. There is no basis for concluding it was the result of magic water or Transformers, and you wouldn’t (or at least shouldn’t) fund magic water – or Transformers – on the NHS as a result of that misplaced attribution.

    Personally, I do think there is room for a holistic approach to medicine within the NHS – but I don’t think handing out placebos should be at the heart of it.

    • Dr. Kaplan August 26, 2010 at 5:46 pm

      @Andrew: You say “*and* there is no basis for it having an effect”
      Now look at this outcome study:
      And all these patients were people who had NOT got better on orthodox treatment from their GPs. Now what would happen to these
      people if those NHS hospitals did not exist.
      In the end it’s about democracy and liberty. A sizeable majority of the people want homeopathy and there are doctors who want to prescribe it.
      A bullying group of people want to stop them getting it. Thankfully both the Labour government and the present coalition did NOT agree and
      defended the democratic right of the people to have it. And stlll the disciples of scientism whinge and moan. Why? Because they are the sort of people who think: “I know better than you what’s good for you!”

  19. Andrew August 26, 2010 at 7:40 pm

    Dr. Kaplan, I refer to my previous response.

    Hypothetically, had I been one of those ‘asthma (under 16)’ patients, I too would have reported a clinical improvement – but it would have had nothing whatsoever to do with homeopathy.

    Some patients will have improved regardless. Some will have improved due to other factors – e.g. changes in diet, exercise, other medication, etc. Some will have improved due to a placebo effect. And so on.

    But there is no basis for believing that any of them improved due to taking homeopathic remedies.

    Furthermore, I do not think we have a democratic right to demand whatever treatment we want on the NHS. Surely you can see why?

    • Dr. Kaplan August 26, 2010 at 9:06 pm

      The way I see it is that these were difficult cases that were helped a great deal by attending Outpatients at The Bristol Homeopathic Hospital. To stop this because some doctors think it’s placebo, or good bedside manner, or dietary advice is simply wrong. What might be right is to do long term studies on the cases that attend these hospitals or compare results of a group of patients that attend homeopathic hospitals to a group selected to receive psychosomatic counselling for the same number of sessions.

      No, we don’t have a democratic right to demand whatever treatment we want. That’s why you have to have a GP REFERRAL to attend an NHS homeopathic clinic. The campaign against homeopathy was disingenuous because instead of seeking to dissuade GPs from referring patients to NHS homeopathic hospitals, it sought instead to thwart them from doing so by diktat from Westminster. The Government correctly saw this as anti-democratic (just as the Labour ex-minister of Health described it as ‘illiberal’) and kicked the draconian, anti-democratic, authoritarian suggestions of the Science and Technology Committee into touch. This came as a big shock to them as they couldn’t quite believe that their scientistic view of health had been trumped by the democratic process and this would have happened under the previous Labour administration as well – even in a recession. Three cheers for democracy!

  20. Andrew August 26, 2010 at 11:02 pm

    That believed they were helped to varying extents.

    Regardless, I still think that’s a rather disingenuous stance to take.

    You appear to be basically saying that if an entity/method/etc. claims to be able to treat some condition(s), and a GP wants to refer people to that entity, they should be allowed to with the NHS paying for it.

    Insert ‘homeopathy’ and you’re for that, yes? What if it was ‘voodoo’? Should we have voodoo hospitals paid for by the NHS?

    GPs, vets, even psychologists are sadly not immune from confusing correlation and causation, and from confirmation bias, etc., etc. A shared belief that something is true does not make it so.

    I don’t think it’s undemocratic to believe there should be a reasonable criteria for treatment paid for on the NHS that goes beyond ‘some GPs and patients think it works, even though the evidence shows it doesn’t do what it claims to do’.

    (And yes, that criteria could apply to some other treatments regarded as conventional – I’m fine with that).

    • Dr. Kaplan August 27, 2010 at 11:05 am

      @Andrew

      Re: your reference to voodoo
      The homeopathic hospitals staffed by doctors were invited to be part of the NHS at its inception in 1948. That means they were paid for by benefactors of homeopathy and patronised by the public prior to this invitation. ‘Voodoo’ did not achieve similar status probably for good reason. Now some would have the NHS appropriate those hospitals and kick out homeopathy? Would that be justice? To Stalinists perhaps but not to democrats.
      And don’t forget that everybody pays National Insurance and the budget for homeopathy is miniscule in relation to the budget for the lot.
      Regarding your last point: I don’t think it’s unreasonable. If you and the opponents of NHS homeopathy campaigned for only EBM across the board on the NHS, I wouldn’t support you but I wouldn’t regard the campaign as duplicitous, disingenuous, hypocritical, anti-democratic and illeberal – all words I’ve used to describe a campaign that seeks to use EBM exclusively to attack NHS homeopathy.

  21. Adam August 31, 2010 at 10:46 am

    Sorry, been away from the computer for a few days, but let’s pick up where we left off.

    “It is disingenuous, hypocritical and duplicitous to use the term EBM to attack and exclude from the NHS homeopathy EXCLUSIVELY rather than use it as a test for NHS admittance across the board for ALL medical interventions.”

    The reason why that is a straw man argument is that to my knowledge, no-one is making that argument. If they were, I agree that it would indeed be hypocritical and all those other things.

    Do you think anyone is attacking homoeopathy on that basis while simultaneously trying to defend other treatments that have been shown to be ineffective? If so, perhaps you could cite examples?

  22. BBC – Biased Reporting | September 16, 2010 at 6:30 pm

    […] most commonly used treatments are actually proven to be clinically effective (for more info read this article here by Dr. Brian Kaplan). So on one hand they disingenuously claim that homeopathy has no clinical […]

  23. Anna March 24, 2011 at 12:55 am

    ADRs are the 5th leading cause of mortality in Europe, we were told at a hearing in Brussels last year, not to mention morbidity, and so the Pie chart is significant as it also clearly shows the limitations of actual efficacy of products.

    As a parent I would be considering an approach and / or treatment that supported the fact that most disease is self limiting, and that resulted in reduced chemical interventions in my otherwise healthy children, especially at the initial stages of illness and disease.

    Homeopathy can also compliment traditional mainstream medicine, a potential partnership supported with the fact that GPs, nurses, and bio chemists have retrained as Homeopaths.

    As a mother, who observes, I find that homeopathy works as part of a healthy life style, as well as not. My children with combined ages of 12 have only used antibiotics once (well one spoon after allergy was noticed) and never anti pyretics for fever. The problems of over use of antibiotics are well known.

    At a Patient Safety conference this year we were told that Hospital Acquired Infections were costing Billions to the UK each year. Various studies estimate that ADRs are also costing the NHS Billions each year, admissions to hospitals for example. So perhaps responsible health care, such as Homeopathy, has actually saved lives if less drugs are necessary / chosen as a result, and saved the NHS millions…enough perhaps to fund the very small amount of funding on Homeopathic treatments on the NHS at £4 million per year.

    Should mention that VIOXX sat well within the EBM model… but clearly have taken up enough space here already…

  24. Anna March 29, 2011 at 11:49 pm

    When Simon Singh challenged that Homeopathy was placebo and tried to compare efficacy to researched drugs and treatment I held up my lovely Pie Chart. BMJ’s Clinical Evidence shows from 2500 treatments supported by good evidence, only 11% of treatments were rated as beneficial, 23% as likely to be beneficial…

    OOPS No comment.

  25. Sastry.M April 3, 2011 at 6:55 pm

    Homeopathy is the true system of medicine for humanity because only human beings are endowed by nature with minds capable of “Conceptual Transformation”(C.T). This presupposes a subtle “Concept” as viewed by mind and “Transformation”observed as a phenomenal event.All scientific explanations are based on this highly evolved capability.
    When we speak of ‘evidence’it is expressed conceptually based on information extracted and supplied by the five sensory organs of our body relating to the physical world. This process in itself constitutes a “Biological Transformsation”(B.T) which is experienced instinctively by all life forms.The prerogative of human mind, however, enables one to build “Evidence” based on experiences cognized directly,stored definitively in brain and recalled factually as evidence.
    A close observation reveals that B.T relating to human beings need not define the same for other life forms like cat’s infra red vision and bat’s ultrasonic audibilty. Therefore ‘evidence’ built on ‘facts’ of human experiences need not puport the ‘truth’ of any phenomenal event.However only human beings can realize ‘truth’ by virtue of mind’s capabilty of C.T.
    Applying the above to human medicine we are constrained to reckon with two definitive factors,viz.1) relating to physical world and 2) relating to chracterization.Eg.the light fragrance of rose and bitter taste of strong coffea.
    The first rlates to B.T and the second to C.T which is highly sensitive and subtle defining instinctive experiences corresponding to B.T. Examples are dog’s high olefactory sensivty and eagle’s telescopic vision.
    Coming back again to human application the basis of Evidence is only built around ‘facts’ of rational experiences conforming to B.T but need not identically comply to the ‘truth’ eluding C.T. Hence scientific theories can be propouded with C.T but has to be verified from rational observations and logical reasoning to unmask the elusive truth. This can safely be done verified exclusively with evidence based on scientifc methods on external physical phenomena. It is because of definable simultaneous relations existing as laws of nature between cause and effect,action and reaction,stimulus and response.etc. If the same methods are used with evidence based on results of medicinal testings by scientific methods this E.B.M may address as a therapeutic agent by virtue of B.T to its rationally verified results but fails to unmask the truth of real cause of any repeated disease manifestations and yet enforce new ones on organism as resulting from biological reaction to stimulating toxic therapeutic effects.
    Viewd from contemporay historical events ,philosophic literature,pharmacopea developed addressing both B.T and C.T simulatneously Homeopathy is the best human medicine as the blessing of God to remedy sufferings of humanity in modern age expressing the scientific truths realized through the inspired works of Dr.Samuel Hahnemann.

  26. Peter Kidson February 18, 2012 at 11:20 am

    The root of the problem here is the elitist/fascist institution of nationalised medical decision-making – a coercively imposed, centralised NHS.

    Rather, let people decide for _themselves_ where their medical spending goes. This will (a) be inherently fairer and democratic, and (b) provide evidence and an open competition between rival approaches, as judged by the customers/consumers rather than by those who would lord over us.

    • Dr. Kaplan February 18, 2012 at 3:21 pm

      ‘You pays your money and you takes your choice’ in other words. Yes it has its merits. However, I personally support a welfare state to a large degree though. Clearly in the case of homeopathy there are those who want to exploit it to support their own ideology – in the case of homeopathy’s detractors, that ideology is scientism. However I support a moral welfare state and NHS that serves the people well. The alternative is the USA where the main people served are the shareholders of the health care insurers. Much more money is spent per capita in the USA than anywhere else in the world, yet the New England Medical Journal of Jan 2010 reports that healthcare in the USA is ranked 37th (sic) in the world. Yes the USA has the best medicine money can buy – as long as you have the money!
      Politically there has been little worth celebrating over the last 75 years here. Imo the following three politicians achieved greatness.
      1. Churchill: for winning the war. (We voted him out immediately afterwards of course – but recently voted him ‘Greatest Briton of all time’
      2. Attlee: for introducting the Welfare State.
      3. Patricia Hewitt: for securing a ban on smoking throughout the land – including in private clubs!

  27. Peter Kidson February 19, 2012 at 12:26 am

    If there was any truth that the NHS was efficient, it would be able to compete in the marketplace on an equal footing. The fact is it needs huge government privileges to keep going, proving that it is inefficient. Your espousal of this totalitarian/fascist approach on which the NHS is base,d is thus groundless.

  28. Peter Kidson February 19, 2012 at 12:32 am

    And if you are going to cheer at the further totalitarian measure of banning smoking in private clubs, then I cannot see what grounds you have for complaining that the same authoritarian institution refuses to pay for homeopathy. “Moral welfare state” – what a joke.

    • Dr. Kaplan February 19, 2012 at 12:38 am

      Indeed a joke! But you took me seriously! LOL ! How could you, Peter? Support authoritarian legislation? Me? It was the punchline of a joke! Ask any comedian to explain the structure of it to you.
      Bwahahahahaha!

  29. David Eyles February 19, 2012 at 8:11 pm

    Being principally a sheep farmer, I have at certain times of the year, as you might imagine, a considerable interest in matters obstetric. So last year I looked up the one review on homoeopathy in the Pregancy and Childbirth section of the Cochrane Library, under Induction of Labour. The review was disappointing for homoeopathic Caulophyllum, much to my surprise. But I carried on looking at the other interventions and then surveyed them into four categories: Positive and safe; positive, but with caveats usually about side effects; effectiveness uncertain; and negative, should not be used. Of the 23 reviews, 13% were Positive and safe; 35% were positive but with caveats; 48% were effectiveness uncertain; and 4% (1 study) were negative, should not be used. These are not quite the same categories of the Medical Evidence pie chart, but they are close enough in description and proportion to suggest that this small sample of the Cochrane system is comparable to the pie chart. Since doing that little survey, I have heard it said that Cochrane is closer to about 80% uncertain, because of its protocols which lead to considerable caution, but that is “anecdotal”.

    But in the lambing situation there have been several times when using caulophyllum has given sudden and very strong contractions in a ewe who has pretty much stopped because she has been trying too long perhaps because of a dead or mal-presented lamb. Several farmers I know use it to help deal with “ringwomb” as a prophylactic. And for the last two years I have been using it to help ewes who are slow to cleanse and have difficulties in milk let down. Experience has lead me to speculate (!) that there may be some sort of link between induction of oxytocin production and the administration of homoeopathic caulophyllum.

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