/, Homeopathy/Homeopathy, Politics and Liberty

Homeopathy, Politics and Liberty

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.

19th 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.

By | 2011-09-25T14:06:58+01:00 September 25th, 2011|Current Affairs, Homeopathy|61 Comments

About the Author:

61 Comments

  1. Andy Lewis September 26, 2011 at 10:56 am

    I know you like to use laughter as part of your therapeutic approach, so thanks for helping me through a Monday morning while I recover from a slight cold.

    I do find it amusing how you keep asserting that the S&T Committee was a ‘political defeat’ and that the government supports homeopathy.

    Their response to the Committee can be seen here:

    [pdf] http://qako.me/raUZev

    The best way of describing their response is summed up in paragraph 8:

    “We agree with many of the Committee’s conclusions and
    recommendations. However, our continued position on the use of homeopathy within the NHS is that the local NHS and clinicians, rather than Whitehall, are best placed to make decisions on what treatment is appropriate for their patients – including complementary or alternative treatments such as homeopathy – and provide accordingly for those
    treatments.”

    In other words, the government wanted to wash its hand of an obviously politically difficult choice. It knew what it should do, but delegated the implementation to others.

    So, whilst not the best outcome for sceptics of homeopathy, at least at the local level, PCTs are continuing to stop funding for ‘naked quackery’.

    (I appear to remember explaining this to you before.)

    • Dr. Kaplan September 26, 2011 at 12:11 pm

      I am glad you find my words amusing and if that helps you get over your cold, so much the better. Yes, successive Government Health Ministers decided (as you have correctly quoted above) that local NHS authorities and clinicians, rather than Whitehall, are best placed to make decisions on what treatment is appropriate for their patients. The key word in that announcement is of course ‘local’. That means that the Government recognises that doctors and health authorities close to the patient are in much the best position to decide whether or not that patient can benefit from NHS homeopathy – no matter how homeopathy works. Government made it clear that it is ethical for these decisions to be made locally as opposed to ‘centrally’ by heavily-lobbied bureaucrats and politicians at Whitehall or (one may add) by central ‘authorities’ on homeopathy such as Ben Goldacre of The Guardian, Tracey Brown of Sense about Science, Simon Singh of the BBC or Edzard Ernst of Exeter. Whichever way you look at it, it was a victory for liberal democracy in that it protected the rights of a significant minority of patients and doctors in the UK.

      Wishing you a quick and natural recovery from your cold.

  2. Andy Lewis September 26, 2011 at 1:49 pm

    I am not sure that sceptics of homeopathy are too concerned who makes the decisions to stop its public funding. You are appear to be happy these decisions are made at local level – and yet these local level decisions have seen homeopathy prescriptions fall eightfold over ten years.

    No matter how you spin it, there is nothing in the S&T committee report, or the government response, that could reverse that trend.

    Indeed, this is the power of the S&T committee report. It can now be used as a solid reference when such decisions are made. And it looks like regulators are adopting it as a standard assessment now both here and abroad.

    The decline in homeopathy will be like a ratchet. One by one , cuts will be made, and will be near irreversible. No one, for example, is going to see a NHS London homeopathic hospital again, after they gave up the fight and retreated into fashionable ‘integrated’ language in an attempt to stop the inexorable decline.

    If this is a political defeat for sceptics then I am happy to be defeated many, many more times.

    • Dr. Kaplan September 26, 2011 at 2:09 pm

      The relentless and seemingly well-funded PR campaign against homeopathy has indeed done damage by mass marketing pressure and nothing else because the criticisms of homeopathy are the same as they have been for 200 years. They have not influenced Government policy though and for that I am thankful. Government has a duty to uphold liberal democracy and patient choice and it has done so. I too hope this happens ‘many, many more times’ because the alternative to liberal democracy is a thought too horrible to contemplate.

  3. Andy Lewis September 26, 2011 at 4:00 pm

    Two questions…

    With respect to this ‘well funded PR campaign’, where do the funds come from and what do you think they are spent on?

    Do you think that the only consideration of how public money is spent on healthcare should be ‘patient choice’? At what point do you think evidence should come into decision making?

    • Dr. Kaplan September 26, 2011 at 8:21 pm

      Q1. Some of the organisations campaigning openly against NHS homeopathy are charities and legally obliged to declare where their funds come from. Find out for yourself by looking them up on Wikipedia.

      Q2. I think a patient’s doctor is best placed to decide what type of medicine his/her patient would most benefit from. To be honest, Andy, that’s exactly where you and I differ. I trust our GPs more than you do. Even though antidepressants have been shown to be no better than placebo for mild and moderate depression in an important meta-analysis by Kirsch et al, I would still trust a GP to prescribe them in an individual case according to his/her judgment. Those who think that we are wasting £232m a year on SSRIs are entitled imo to try to dissuade GPs from prescribing them in cases of mild and moderate depression just as those who don’t believe in homeopathy should be fully entitled to try to dissuade GPs from referring patients for homeopathic medicines (NHS budget £10m). GPs however should not be THWARTED by centralised authorities from choosing either homeopathy OR antidepressants for any individual patient. Homeopathic NHS doctors are fully accountable for what they do and it’s no coincidence that all homeopathic doctors fall into the lowest bracket of insurance premium when it comes to insurance against medical negligence.

  4. Andy Lewis September 26, 2011 at 10:49 pm

    Q1 You did not answer my question and tried to get me to dig up the justifications for your conspiracy theory. WOuld you like to try again?

    Q2 You are now switching from ‘patient choice’ to ‘GP’s choice’. Which is it?

    • Dr. Kaplan September 26, 2011 at 11:01 pm

      Q1. First of all I said ‘supposedly well-funded’ Second of all I gave you the answer. A look at the Wikipedia entrance of prominent organisations compaigning against homeopathy will reveal that some are charities that have to declare their funding. It’s no secret this. Nor is it a consipiracy theory. Many people are aware of this. I’ve done the simple research involved and if you want to you can too.
      Q2. Both. Patients can try to ‘choose’ homeopathy by requesting it from their GP but only if their GP agrees or recommends it himself in the first place and the patient likes the idea, can a patient be seen by an NHS homeopathic doctor.

  5. Andy Lewis September 26, 2011 at 11:12 pm

    Q1. Firstly, you assume that some group is in control of the ‘relentless and seemingly well-funded PR campaign against homeopathy’. Secondly, you assert it is a ‘PR campaign’. A PR campaign for whom? Secret control and un-named beneficiaries make it a conspiracy theory. The facts would suggest that various concerned individuals and groups are highlighting the problems with homeopathy and no vested interests are driving this – beyond intellectual and humanitarian interests. If you want to assert otherwise, I suggest you be brave enough to state your case openly.

    Q2. OK. So I agree that medical treatments should combine the wishes of the patient with the professional choice of the GP. However, you still ignore the second part of the quesiton: at what point do you think evidence should come into decision making?

  6. Andy Lewis September 26, 2011 at 11:58 pm

    I am reluctant to do your donkey work for you, but the BMJ letter you blog about above came from members of HealthWatch – a long standing charity promoting EBM.

    Their website states “we rely primarily on our members’ subscriptions”. And that ” we have resolved as a matter of policy that not more than 25% of our income in any year may come from any one company.”

    Their income for their last return was £9,100 of which they spent £6,207.

    Is a few thousand quid all it requires to fund a “relentless and seemingly well-funded PR campaign against homeopathy.”

    Would you like to re-assess your conspiracy claims?

    • Dr. Kaplan September 27, 2011 at 1:02 am

      On Q2: Glad you agree. On evidence: The GP surveys the evidence himself/herself in his/her own way and makes a clinical decision in the interest of his/her patient.

      On Q1: I really am not a conspiracy theorist. I say ‘seemingly’ means ‘seemingly’ and if you say: ‘The facts would suggest that various concerned individuals and groups are highlighting the problems with homeopathy and no vested interests are driving this – beyond intellectual and humanitarian interests.’ – then ‘intellectual and humanitarian interests’ it is, although I would opine considerably more of the former than the latter.

  7. Andy Lewis September 27, 2011 at 7:25 am

    Q1. Well ‘seemingly’ the facts go against a “well funded PR campaign” and you have not said how you ‘seemingly’ come to the opposite conclusion. Unless you wish to cast aspersions. That is not the case, is it?

    Q2. You now appear to take the position that treatments should be prescribed on the basis of joint decision making between the doctor and patient taking into account a review of the available evidence. I would not want to put words in your mouth, so please let me know if I am wrong.

    But if groups of people are concerned that a few doctors continue to prescribe homeopathy against the evidence using public funds, how is that ‘against liberal democracy’? At what point does our current liberal democracy have a say if members of the public see a few doctors apparently misusing publicly funded resources?

    PS As you are a private doctor, this argument does not apply to you – you are free to work within whatever professional bounds you feel apply – but this is a debate about public funding, so I shall stick to that for now.

    • Dr. Kaplan September 27, 2011 at 10:45 am

      This discussion isn’t going anywhere anymore. I thought I made it perfectly clear that doctors (while remaining fully accountable) should be allowed to make clinical decisions (based on individual assessment of evidence) in the best interests of their patients. This may involve using homeopathic medicines, sending patients to NHS homeopathic hospitals and even prescribing SSRI antidepressants because they think they might help a particular individual (even though a major study shows these SSRIs are not better than placebo in mild and moderate cases of depresssion). To use EBM to attack homeopathy exclusively and call for legislation against it while huge swathes of conventional medicine lack evidence – is rather strange behaviour by people with ‘no vested interests…. beyond intellectual and humanitarian interests.’

  8. Andrew Sikorski MBBS MRCGP MFHom September 27, 2011 at 1:08 pm

    Having watched the Dr Who episode last weekend I am struck by the ‘cyberman’ type of invective unleashed by those lovely people who do not, and frankly are unlikely to ‘get’, Homeopathy and CAM. THere is a terrific ‘them and us’ attitude- really it is amazing in its artistic intensity- when in fact there is only ‘US’. We are all human and we all want health and happiness with a bit of wealth thrown in , perhaps. To this end people have sought healing from shamans, herbs and flowers, quacks and doctors and surgeons over the ages. Without ill people all these practitioners would have been without an occupation! Helping ill people to get better is the nub of the issue and for every individual person there is going to be their way of going about it. Even siamese twins with the same medical conditions on the same drugs will find themselves seeing their doctors in different ways and taking their drugs differently! We each have a constitutional right to do with our bodies as we wish- even trying to take a patient’s blood pressure without their consent is deemed actual bodily harm by the courts.

    Amazingly the BMJ published a letter which I submitted. I implore everyone- all you lovely, wonderful and incredible folk to remember medical intervention and care is about helping people to get over their illnesses and back to an even keel as much as is possible and with their consent. Doctors went into the profession to help the sick, although we were told under no circumstances should we tell our interviewers this deep belief when we applied for Med School.

    Here’s my letter- and I welcome any ‘straw men’ to hurl their tenderly nurtured and thought through comments if they so desire. Lots of LOVE- the big one universal love to you all! I love you unconditionally and assert my right to disagree with you.

    http://www.bmj.com/content/343/bmj.d5960/reply#bmj_el_270540

    The Emperor wears no clothes!?
    Andrew D Sikorski, GP
    RCGP, Faculty of Homeopathy
    Whilst the “aims of the BMJ are to publish rigorous accessible information that will help doctors improve their practice” one hopes an additional reason would be to help relieve patients’ symptoms?

    Realising the BMJ is keen for its members to write in (BMJ2003;326:985 ) to express their opinions I am doing so in response to a letter by Obstetric consultant Susan Bewley which you published, ironically, on the page following your extensive editorial on ‘Placebo by Proxy’. The letter gives voice to non GMC/ non BMA ‘armchair clinicians’ who are not involved in clinical care and who have a bigoted opinion on Homeopathy.

    Did you know that patients like and respond to cost effective Homeopathy- especially those who have had failedinterventions from secondary care colleagues? http://www.facultyofhomeopathy.org/research/clinical_outcomes_studies.html

    Did you know there is RCT scientific evidence Homeopathy works?http://www.facultyofhomeopathy.org/research/

    Did you know there are some 400 GMC registered colleagues belonging to the Faculty of Homeopathy, some of whom are even BMA members, who incorporate Homeopathy in their daily clinical practice? http://www.facultyofhomeopathy.org/about_us/

    Did you know clinical doctors who were initially most sceptical of Homeopathy (their number includes myself) having looked into Homeopathy become some of Homeopathy’s strongest advocates?

    Did you know Homeopathy is utterly different from a molecule in a drop in the oceans?

    Did you know Digoxin and Ritalin act on Homeopathic principles?

    Did you know there is an undemocratic minority lobby group whose members comprise the groups Sense about Science and Nightingale Collabortion who act to remove a person’s constitutional right to choose which form of therapy they seek to help their symptoms with? The Nightingale Collaboration has published the CAP guidelines relating to homeopathic advertising drawn up by CAP on Friday, before these guidelines are even published by the CAP on their own website!

    Did you know there is no single proven effective medical treatment for any condition with the term ‘syndrome’ in the diagnosis?

    In my practice it is particularly those people with long term chronic conditions and the ‘heartsinks’ who appear to have found benefit from Homeopathy, making my GP working day sweeter.

    Patients deserve to continue to be able to access Homeopathy, which has been available alongside standard treatment as a complementary therapy on the NHS, since the inception of the NHS, particularly when your own BMJclinical evidence data (http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp) indicate how inadequate our current knowledge is and especially at this time of financial difficulty.

    Meanwhile research should continue to further advance our understanding of the effects of Homeopathy which continues to have real effects in patients’ lives.

    Yours sincerely

    Andrew Sikorski MBBS MRCGP MFHom.

    Competing interests: Dr Sikorski is a conventional NHS GP partner practicing integrated medicine including homeopathy alongside usual care.

    • Dr. Kaplan September 27, 2011 at 1:22 pm

      Superb stuff, Andrew. It’s good to know that the BMJ pubiished such an honest, revealing and heartfelt letter. Well done!

  9. Peter Vintner September 28, 2011 at 3:15 am

    Dear Doctor Kaplan (and Sikorski if you wish), I defy you to produce one (just one) verifiable, incontrovertible, properly documented case of a non-self-limiting condition being cured by a 20C or 30C homeopathic “remedy”. With a clear explanation of what the remedy was and the mechanism by which it worked. Even better if you can come up with a case involving a 200C dilution.

    In the 200+ years since the invention of homeopathy, with all the meticulous records of unmitigated success, it should be possible for you to produce millions of cases. But one will do.

    Good luck.

    • Dr. Kaplan September 28, 2011 at 9:52 am

      Cases there are a plenty and many have stepped forward. In fact there is a big outcome study that answers your question. It is RCTs that are not always perfect for studying a whole person medical approach. It is also the ‘clear explanation of… the mechanism by which it worked’ that nobody has been able to demonstrate. This is always the case when one attempts to stimulate the innate healing ability of an organism by whatever means: homeopathy, acupuncture, ayurvedic medicine etc. It remains however, the oldest form of healing and in sensible hands dovetails beautifully with a conventional scientific medical approach.

  10. Andy Lewis September 28, 2011 at 1:48 pm

    It appears to be incredible that you are citing the Bristol satisfaction survey as evidence. It makes me wonder if you are not just a massive homeopathic troll.

    • Dr. Kaplan September 28, 2011 at 6:03 pm

      Yes I do cite it as evidence. Outcome is very important to me. True Scientists would be most curious about WHY Bristol gets such positive outcomes rather than
      trashing homeopathy and its practitioners. Obviously something GOOD is happening there and even sceptics – especially those with ‘intellectual and humanitarian’ interests, should be curious to find out exactly why and how such good results were obtained – esp with patients that were NOT responding to conventional medicine, the typical NHS homeopathic patient. This is very important. A disciple of scientism however might prefer to trash anything that doesn’t conform to his/her particular view of hwo the universe works of course, but I would not deem such an attitude ‘humanitarian’. Medicine is an art based upon science, not scientism and ‘science’ means knowledge. Science would want to know more about Bristol, scientism not.

  11. Andy Lewis September 28, 2011 at 7:51 pm

    Outcome is of course important. But, as you well know, this study is incapable of answering any questions about the chances of patients getting better outcomes under homeopathic care, as this was a poorly conducted longitudinal observational study that failed to take into account many confounding factors such as the effects of mainstream treatments, drop outs, deaths and so on. It did not compare the homeopathic treatment with anything. It cannot even show there was a placebo effect.

    Dr Kaplan – you are not an uneducated lay homeopath. Understanding how you interpret trial results ought to be routine for you. And I believe you can.

    So, why you present the Spence paper as evidence of improved outcomes under homeopathic care baffles me.

    • Dr. Kaplan September 29, 2011 at 7:59 pm

      Yes, interpretation of trials and meta-analyses is complicated. I think the mass of homeopathic trials show that homeopathy works as do all outcome trials; you don’t. We are never going to agree on this or probably anything else and there is little point continuing to debate it between the two of us. However I am ALWAYS open to a PUBLIC debate on provision of NHS homeopathy and have always attended any held in London. The difference between that and this discussion is that an audience might give us some feedback on who is making a better case for their position. The paradigms from which we discuss/argue are lightyears apart and I absolutely refuse to let the sceptics/detractors/denialists of homeopathy dictate the very way this issue is discussed.

      Bottom Line: You guys have done very well in The Guardian and on the BBC and other media. Congratulations on fighting well in the realm of PR. But in the realm of pure politics, you lost. QED in this post.

  12. Andrew Sikorski September 28, 2011 at 10:25 pm

    Peter’s comment is that of a desperate straw man. Paracetamol- ever taken that or given it to your child as calpol? Peter, please explain to us how this pharmaceutical product, routinely advertised for sale over the counter for children, please, please explain how it works? Being so authoritative you must surely know and it would be churlish to keep this information to yourself when no-one else seems to know paracetamol’s mode of action nor why or how it works? Surely you would wish all medicinal products sold in a chemist to be subject to the same strict standards, or wouldn’t you?

    • Dr. Kaplan September 29, 2011 at 8:04 pm

      Re: your question about ‘same strict standards’ being applied on a level playing field for homeopathy and ‘conventiional’ medicine: ‘The answer my friend is blowing in the BMJ’s ‘Clinical Evidence’.

      Double standards? That would be putting it euphemistically.

  13. Andrew Sikorski September 30, 2011 at 12:43 am

    Just before the strawmen/ cybermen/ trifids come back to bring attention to the rapid response from the nightingale collabortion in the BMJ it seemed prudent to post my rapid reply thereto:
    Sir,

    I am deeply grateful to Ms MClaghlin for her comments and somewhat surprised she has not been more scathing.

    I congratulate her on not complaining that homeopaths offer benefit to patients with asthma, eczema, arthritis, depression, allergies, irritable bowel syndrome and many other illnessse, but kept to a rather limited list and hope she will not be as vocal about banning the unproven and widely advertised over the counter remedy ‘paracetamol’ sold for profit to children as ‘calpol’, despite having greater liver toxicity than the herbal remedy Kava Kava which was banned….for liver toxicity, as my headaches would be much more difficult to deal with.

    I understand barely 200 complaints were lodged with the Advertising Standards Authority.

    My usually reliable sources must have been having an off day, much like the sources she has sought advice from who have given her and her collaborators inaccurate information regarding: the existence of research proving the effect above placebo of Homeopathic medicinal drugs; patients finding Homeopathy palatable and free of side-effects; useful alongside conventional treatments; growing in popularity; a useful adjunct for a Doctor to employ in helping sick people heal; extremely widespread in Europe and particularly in India; cheap and cost-effective; a person’s right to seek out; able to almost eliminate the incidence of Leptospirosis in the homeopathicly treated regions of Cuba and the fact real patients’ illness experience pathways have seen extremely significant benefits from Homeopathy after failed interventions from secondary care medical colleagues. She should check her sources.

    I warmly congratulate her on not finding fault with any of the rest of my letter, ergo agreeing with me on the finer points therein.

    Yours sincerely

    Andrew Sikorski

  14. Andy Lewis September 30, 2011 at 9:04 am

    We are never going to agree on this if you do not engage with the criticisms of the studies you tout as evidence.

    A central question for the Spence trial:

    The Bristol trial looked at many self-limiting conditions such as menopause. How do you use your special homeopathic way of looking at trials to determine what the baseline improvement would have been?

    By the way, I think the only reason you want public debate is because it is much easier to avoid specific questions and just play at the level of supericiality and soundbites.

    You know you can just keep on repeating myths like the BMJ Clinical evidence myth and know your opponent cannot respond in that forum to all of them.

    • Dr. Kaplan September 30, 2011 at 11:46 am

      The ‘BMJ myth’ ? That’s funny Andy! Now is that ‘myth’ the British Medical Journal itself or the British Medical Journal’s excellent handbook called Clinical Evidence? Or is it simply the PAGE in Clinical Evidence that shows that only 11% of commonly used treatments really work and a further 23% probably work and the rest either don’t work, have an unknown effect or make patients worse? Now of course I empathise with how inconvenient those statistics are to homeopathy’s denialists because they invite them to STATE A LEVEL OF EVIDENCE NEEDED FOR AN INTERVENTION TO BE INCLUDED ON THE NHS – something they are rather persistent about not doing presumably because it would create a level playing field for all medical interventions and logically require them to extend their vituperative and insulting remarks to describe some well-known (though rather evidence-free) conventional treatments such as SSRIs for mild and moderate depression
      Although I will not necessarily give ‘mythical’ status to the BMJ’s Clinical Evidence Handbook, I’ll continute to quote it until someone explains to me what I am missing. And the rubbish about it apparently ‘including CAM’ treatments won’t stick. I’ve read the whole book and there are no more than a handful of herbal and natural treatments listed among thousands of conventional orthodox treatments that rather inconveniently have zero evidence behind them.
      This is THE publication that exposes the blatant hypocrisy of the nasty, insulting attacks on homeopathy. If you think it misleads the public, then why don’t you write to the BMJ and complain about it or is the BMJ only to be used by CAM’s detractors to write nasty letters about homeopathy?

  15. Andy Lewis September 30, 2011 at 3:19 pm

    Brian – your Clinical Evidence argument relies on a simple myth and a misrepresentation.

    The figures come from a list of 3000 interventions on their database. The figures tell us nothing about what level of treatments being used in clinical practice are based on good evidence. This has been pointed out many times and I am at a loss to understand why this still crops up. If you were ill, and go into hospital, the chances of you receiving an evidence based effective treatment is not 11%.

    Secondly, Clincial Evidence page is a call to action to ensure more evidence is gained for treatments that are not backed by good evidence. It is not a justification for people who practice pseudo-medical treatments such as homeopathy to ignore the need for evidence and pretend they operate on some level playing field.

    The hypocrisy is entirely on your part. You tout useless studies, such as the Bristol study, as good evidence and ignore the overwhelming evidence that all you do is prescribe inert sugar pills.

    • Dr. Kaplan September 30, 2011 at 5:59 pm

      As I said Andy, it is unlikely that either of us will convince the other. An audience might give us an idea of well we make our cases. Convincing an audience or an electorate is what democracy is all about. Perhaps we can agree to disagree on the clinical effect of homeopathic medicines, but at least concur that nobody’s individual views no matter how strongly held or justified by science or scientism (which really can be a subjective issue) should EVER be allowed to trump the due democratic process.

  16. Amit Habbu September 30, 2011 at 5:56 pm

    Peter, i can put before you a case of a 70 year old lady with ovarian carcinoma, Stage III, with malignant ascites. She had anaphylactic reaction to paclitaxel and was given the second line chemotherapy with Gemcitabine Cisplatin at TATA Memorial Hospital, Bombay, India. However clinical and biochemical response was poor with steadily increasing ascites and CA 125 tumor marker levels ( nearly 1500 ). The oncologists adviced palliative care when she started homeopathy. She was put on Aurum mur nat 200 potency once every 2 weeks and Ars alb 30 potency daily. And has been on the same prescription for nearly a year now. Follow up CA 125 level is now 2 and CT scan shows complete resolution of ascites.

    The response is convincing and durable, even from the oncologist’s perspective here.

    The only question that i cannot answer is the mechanism of action.

    With the patient’s permission i can produce all required documents if needed

  17. Andy Lewis October 1, 2011 at 1:01 am

    It is indeed unlikely that either of us will convince the other. But it is worth exploring why.

    I have presented why I think your evidence from the Bristol study is worthless and why your interpretation of the the Clincial Evidence ‘call to action’ message is misleading.

    But you do not achnowledge these issues. You carry on as if these counterarguments have not been made.

    And to prove the point you start reverting back to the idea that this is about ‘democracy’ when we had established above that it was much more about decision making between patient and doctor using the best available evidence. You keep trying to pretend that people voicing their concerns about the public funding of homeopathy is ‘undemocractic’ when it is the exact opposite.

    No wonder progress is made when you stick to zombie arguments. No matter how many times they are slain, they rise up and continue their slow, shuffling advance.

    • Dr. Kaplan October 1, 2011 at 2:23 pm

      Andy, may I suggest that you look at the title of the post about which we are having this discussion. It’s not abour RCTs, dilutions or Avogadro’s number; it’s about politics. Both the Labour and Coalition Governments have heard all your points and mine, considered ALL the evidence presented (not only the evidence considered acceptable by the disciples of Scientism) and decided to continue the funding of NHS homeopathy. QED. But still the disciples of Scientism foam at the mouth in fury at their political defeats and go running to their ‘friends’ on The Guardian and ‘neutral’ BBC for succour and write vituperative and disingenuous letters to the Lancet and BMJ using gross terms like ‘naked quackery’ Why don’t you just enjoy your victories in the Guardian and on BBC (inexplicably and inexcusably biased on this issue for a supposedly neutral service funded by a compulsory license fee whether you watch the BBC or not!). In Parliament the Scientismists* put up a hell of a fight with that S&T Committee but in the end YOU LOST. Parliament and democracy does not have an infinite amount of time to listen to this petty issue involving a tiny % of NHS funds. I sincerely suggest you acquire some of that most English of qualities – the ability to lose with dignity and grace.

      *Evan Harris, a scientismist’s scientismist if ever there was one, really put the boot in for you guys at those hearings. Unfortunately for him and his viewpoint:
      1. Labour’s Mike O’Brien told the committee that it would be ‘illiberal’ (must have been a bit embarassing for a ‘liberal’ democrat to hear that) to withdraw funding for NHS homeopathy.
      2. At the very time of the Clegg-induced Libdem revival, he loses his seat as an MP to a unheard of Christian South African.
      3. The Coalition Minister of Health, Anne Milton, reiterates the views of the Labour minister to the letter.

      It may not be scientific enough for you. It may not be mathematical or logical to you. But it is Democracy. And heaven help us if we abandon it because the alternative is a thought too horrible to contemplate.

  18. Andy Lewis October 1, 2011 at 4:38 pm

    Brian,

    I have no need to look to my “‘friends’ on The Guardian and ‘neutral’ BBC” for succour. I have no need to assume that the S&T Evidence review was a defeat.

    I just need to know that NHS homeopathy is almost ten times smaller than it was a decade ago. I simply need to see organisations such as the ASA relying on it as the latest sound review.

    And I just need to hear people laughing about it in a pub because they have become aware of campaigns such as ten23.

    Because of such things, I know the direction of history is on my side.

    When medical homeopaths such as yourself start trying to stop the hideous abuse of this quackery in places in India and Africa then maybe you will get an easier time. But right now, you are part of the problem and so are caught up in this whether you like it or not.

    This is nothing to do with democracy. In the same way that road campaigners trying to stop speeders or uninsured drivers is anti-democratic.

    By painting this debate as something to do with freedom of choice, you are receding into the last refuges of quackery. It is transparent to all those who watch you. And does not paint you in a good light.

    • Dr. Kaplan October 1, 2011 at 5:34 pm

      Thanks for the homily Andy. I and the 500 000 Indian homeopaths you accuse of ‘hideous abuse of quackery’ will meditate on your humane words of wisdom which clearly emanate from your deeply philanthropic philosophical position. Even if both Labour and Coalition Governments comprehensively disagree with you, at least you can derive great satisfaction from the fact that at least The Guardian, The BBC and the ‘guys down the pub’ concur with your point of view. Congratulations on that. I would like to terminate this particular discussion but offer you the last word which I will publish as long as it does not contain abusive terms such as ‘the hideous abuse of this quackery’ a phrase that is insulting, easy-to-refute and says much more about you than it does about myself and hundreds of thousands of homeopaths and homeopathic doctors as well as many millions of homeopathic patients worldwide.

  19. Andy Lewis October 1, 2011 at 7:03 pm

    I refer you to my first comment on this post.

  20. anarchic teapot October 1, 2011 at 7:13 pm

    Most instructive. One side remains unfialingly polite, but has the temerity to ask questions until they’re answered; the other uses blustering, self-referrence, and displays a strange preference for “democracy” in a non-political situation.

    May I humbly enquire as to when politics had their place in medical science?

    • Dr. Kaplan October 1, 2011 at 9:48 pm

      HI Squonk, I remember a Genesis track with that name on A Trick of the Tail.

      Re: ‘polite’: your understanding of the word is different from mine. Accusing homeopaths and homeopathic doctors (who genuinely believe in the medicines they use however deluded or naive others may think they are) of ‘hideous abuse of this quackery’ is less than ‘polite’ in my book.

      Re: ‘non-political situation’ When a bunch of MPs with an axe to grind against homeopathy forms a Science and Technology Committee that meets at Westminster and then makes draconian recommendations utterly hostile to NHS homeopathy – you say that is a ‘non-political situation’? When Ministers of Health of both Labour and Coalition reject ALL the vile recommendations of the committee – that’s not political either? Not sure what you think IS political, squonk.

      Re: Place of politics in medical science: Politics has no place in medical science. It has however, a huge place in the provision of medical care, especially when we have a NHS that is funded by national insurance. When you have that, you need to hear the voice of the people and the fact (as mentioned by both Health Ministers, Labour and Coalition) is that many people want NHS homeopathy and feel that they benefit from it. Governments in liberal democracies respect the rights of sizeable minorities and that is exactly the position of both Labour and Coalition governments and we are thankful for that.

      If industrial science, corporate science, para-science and particularly scientism masquerade as ‘Science’ and manage to trump democracy, our society will enter the dark ages as happened in China and the USSR under Mao and Stalin respectively. My stance on this has always been utterly political and so far two Governments in this country have happened to agree with me in terms of policy even if Andy Lewis, Simon Singh, Edzard Ernst, Michael Baum, David Colquhoun et al have not.

  21. anarchic teapot October 1, 2011 at 10:16 pm

    So Brian, since we appear to be on intimate terms, as homeopathy has no scientific basis whatsoever, your campaign to get it paid for by the taxpayer is a purely political gambit?

    Scientism…scientism… Ah, here it is: “the belief that magic has a place in science”. I paraphrase, but I do not mistranslate. I would advise you not to use that word if you wish to be taken seriously in a rational debate.

    • Dr. Kaplan October 2, 2011 at 10:30 am

      Squonk, I don’t know where you get that definition from. Try its Wikipedia entrance for a comprehensive definition. It’s a neologue so no definition has been accepted by OED etc but I think the Wiki one is a bit better than what you have come up with
      I don’t know where you get the idea that I am campaigning to get homeopathy ‘paid for by taxpayer’ Homeopathy has been part of the NHS since several pre-existing homeopathic hospitals WERE INVITED to be part of the NHS by the Government that created the NHS in 1948. Just history.

  22. Paul Morgan October 2, 2011 at 12:00 am

    I really cannot believe that Andrew Sikorski has to ask about the mechanism of action of paracetamol. I’ll make it easy for him:-
    http://en.wikipedia.org/wiki/Paracetamol
    But, then again, perhaps I shouldn’t be surprised as all this blog and the comments on it demonstrate yet again that the homeopaths are incapable of providing a single piece of credible scientific evidence demonstrating any efficacy for homeopathy over placebo and regression towards the mean. And, of course, they trot out the same old claims about a war on homeopathy being somehow funded by “Big Pharma” (heard of Boiron, have you? A multi-million dollar business) – Gorski’s Law at least has some grounding in reality unlike the so-called laws of homeopathy.
    As for politics having no role in medical science, now that really is a bizarre and ill-informed statement. As a taxpayer paying money to help found the NHS, I do not want to see the NHS funding therapies which have been proved to be ineffective. Whilst doctors and scientists can advise, lobby and cajole politicians about NHS funding, ultimately the decisions on how our taxes are spent – including on health – are made by politicians. If you don’t like how politicians spend tax monies, vote for someone else.

    • Dr. Kaplan October 2, 2011 at 11:23 am

      Dear Paul,
      I refer you to my comments on politics have no role in medical science but a huge role in the provision of healthcare. Btw homeopathy has always had its critics – including when it was invited to be part of the NHS – and those criticisms were no different from the ones we hear today. What we see now is that the voices of denial have become much louder, aggressive and better organised as well as gaining huge support from the Guardian and supposedly neutral BBC. I don’t know about funding but it’s certainly a very well orchestrated PR campaign and one thing I know about PR is that it usually doesn’t come cheap.

  23. Peter Vintner October 2, 2011 at 12:32 am

    There are no cases of non-self-limiting diseases being cured by homeopathic “remedy”. Not a single one. After 200 years there should be millions upon millions if what homeopaths say is true. But all we have in reality are anecdotes, and most of those on the anecdotalist’s and homeopth’s favourite modern medium, the Internet. The reason for this that homeopathy is, quite demonstrably, medical fraud.

    A good test of this would be for Dr Kaplan to infect himself with meningitis, or typhoid, or malaria, and treat himself exclusively with homeopathic remedies. But you, good Dr Kaplan, won’t do this because you know what the outcome would be. You would die, just as anyone else doing the same pointless exercise. If you dispute this then I challenge you to do it. Think of the boost it would give to homeopathy worldwide, and Big Pharma killed at a stroke.
    But as I said, you won’t do it.

    Homeopathy is good business but it is nevertheless a despicable fraud, promoted and perpetrated mostly by despicable, second rate people. Who but a bunch of charlatans would claim a client satisfaction survey to be evidence of the medical efficacy of homeopathy? This is the real level of any debate about the place of fraudulent medicine in a civilised society – client satisfaction surveys as evidence.

    Claims for the medical efficacy of homeopathy are as demonstrably ridiculous as insisting the Earth is flat and the moon made of cheese. Unfortunately claims for homeopathy can have rather more catastrophic consequences that the other two.
    I will go so far as to say that there are only two types of homeopath – the utterly deluded, and the utterly dishonest. And not one willing to put their money where their mouth is and demonstrate it on themselves.
    Typhoid, Dr Kaplan. Meningitis, Dr Kaplan. You could do them. Malaria, Dr Kaplan… you could test the homeopathic prophylactic there, if your confidence in your quackery were actually real.
    In fact I suggest a Homeopath group demonstration. It would do so much more to convince idiots like me that your “remedies” are worth more than water and sugar. But you and I know you won’t. And we know why don’t we.

    • Dr. Kaplan October 2, 2011 at 10:39 am

      Okay Peter, I’ve published you this time. But I won’t publish ad hominem insults from you again even though you are clearly a ‘first rate person’ whereas I and my colleagues are apparently ‘despicable second rate people’. Okay I get your point. Because I won’t take up your suggestion of doing insane and inane medical experimentation on myself, homeopathy clearly cannot work. As a criticism of homeopathy, I’ll put that one in the ‘Innovative File’.

  24. Dr. Nancy Malik October 2, 2011 at 9:47 am

    204 human studies published in 86 peer-reviewed international medical journals out of which 96+ are FULL TEXT out of which 94 are PDF which can be downloaded at http://bit.ly/gFJIbg

    • Dr. Kaplan October 2, 2011 at 10:33 am

      Thank you very much for that. Good to have that link here.

  25. Paul Morgan October 2, 2011 at 7:02 pm

    Good old Nancy Malik trolling out the same old list of poor studies which superficially appear to support claims of benefit for homeopathy but which on adequate scientific scrutiny fail to do so because of serious methodological problems, such as randomisation, power, etc. This has been pointed out on numerous websites and blogs previously, but she seems incapable of grasping such basic information that these studies are useless as scientific evidence.
    Dr. Kaplan, the existence of the homeopathic hospitals within the NHS is an accident of history rather than any positive decision to “invite” them to be part of the NHS. They are now withering away to nothingness. Good, I say – stop wasting taxpayers money on this nonsense.
    As for the funding of any anti-homeopathy campaign, please produce evidence to substantiate this claim. Of course, I do realise that producing credible evidence seems to be a real problem for homeopaths. However, if you cannot produce evidence to support your claims of funding for an anti-homeopathy campaign, have the good grace to admit that there is no evidence. Failing to do so will only serve to make your claims look as ridiculous as the claims for benefit for homeopathy are.

    • Dr. Kaplan October 2, 2011 at 7:24 pm

      Dear Paul,
      This post is about Politics and Homeopathy and the NHS. Two Governments have looked at the ‘evidence’ about homeopathy and come to the conclusion that it is best left to GPs and local health authorities (rather than anti-homeopathic activists) to decide whether THEIR PATIENTS receive NHS homeopathy. I happen to agree with that decision and that is the point and the whole point of this particular post. You are entitled to your opinion of course but two successive Governments tend to have agreed with me and you must learn to accept the democratic process even when you don’t agreed with it.
      As to the funding of the anti-homeopathic PR campaign, I can only say the following.
      1. It is a powerful and relentless PR campaign that seems remarkably undeterred by two severe political defeats at Westminster.
      2. It appears to be heavily supported by The Guardian (as is their right) and the BBC (as is not their right as they are funded by a compulsory license fee and are meant to be neutral)
      3. I have looked up some of the organisations that campaign against homeopathy on Wikipedia and those that are charities are required to give names of donors. Anyone can look these up themselves. But Wikipedia is not infallible and so you are right – I don’t have incontrovertible evidence nor do I want to be sucked into that sort of discussion which is tangential to the subject of this post. What I described as a ‘seemingly well-funded campaign’ may really be just a dedicated, selfless, tireless bunch of well-meaning activists donating their time and labour philanthropically and altruistically to try to improve our society and help the Britisth public by campaigning to THWART GPs from sending their own patients to other fully qualified and fully accountable homeopathic doctors working at NHS homeopathic hospitals.

  26. Paul Morgan October 3, 2011 at 12:45 am

    Two successive governments simply haven’t had the balls to make the decision to listen to the conclusions of the Science and Technology Committee. To call that two “severe political defeats” is stretching credulity somewhat. Politicians primary drive is to not piss off voters, no matter how stupid the idea is.
    I asked you for the evidence of funding -you have presented nothing. So, please, to stop your claims being looked upon as ridiculous, list those who have donated to your alleged “well funded” campaign against homeopathy. List the organisations and list the donors. Otherwise, people will think you are making it up. But to counterbalance, let’s not forget the efforts of companies making homeopathic “remedies” to continue promoting it – I’m sure you’ve heard of Boiron.

    • Dr. Kaplan October 3, 2011 at 10:27 am

      Dear Paul,
      I said ‘seemingly well-funded campaign’ and I’m going to leave it at that. In any case this is utterly tangential to the main point of my most recent post. I’ve no interest in discussing this point any further. If I think it’s ‘seemingly well-funded’ then regard it as my opinion.

      I am going to assume from your email address that you are medically trained and that we are both doctors. So let me define the present political position wrt homeopathy and the NHS as regards the two of us as medical professionals.

      1. For a patient to receive homeopathic care on the NHS, they have to be referred by their GP. Their GP has every right to look at ALL the evidence including the S&T’s ‘conclusions’ and either refer or not refer. To me this should be quite sufficient protection of patients (from the point of view of homeopathy’s detractors. For you it is not. For you these GPs must be officially THWARTED from being able to do this. From this I infer: I trust the UKs General Practitioners to make decisions in their interest of their patients more than you do.

      2. Two Governments have refused to be pressurized into centrally preventing GPs sending their own patients to other NHS doctors for homeopathy. You say this is because they ‘haven’t had the balls’ to do it. I say they value democracy enough to respect a significant minority of patients and doctors in the UK.

      3. From the points above I can conclude that I ally myself totally with liberal democratic government and have learned to accept decisions that I agree with and those with which I don’t. (read Plato on how Socrates accepted his death sentence because it was decreed by a democracy even though to him (and us) it was manifestly wrong) You, however, favour a more authoritarian politics where minority views are of less importance and a more totalatarian government (that has ‘the balls’ to impose laws on the people that many of them clearly do not want) is quite acceptable. That is your right and privilege. Your only problem is that Labour and Coalition Governments do not concur on something that you feel very, very strongly about. You must have totally lost respect for all three main parties in this country because of this issuse. Thus it would be best that you and the other homeopathic denialists form your own party perhaps The Party of Scientism or if you like The Sensible Scientific Party and see how you do in any election. Perhaps do this when we elect Euro MPs because PR will show you your full support in this country. I wish you well on the hustings.

  27. Paul Morgan October 3, 2011 at 8:32 pm

    Dr. Kaplan, I sense you are getting angry. I’m not. Let’s look at this as dispassionately as possible.
    You made an allegation that there was a well-funded anti-homeopathy campaign being conducted in the UK. You presented no evidence of such funding when pressed and now admit that it’s just your personal opinion. Conclusion? There is no such “well-funded” campaign. Glad we got that sorted out.

    Homeopathy on the NHS is slowly dying. As a taxpayer, all I can say to this is “good”. Taxpayers’ money should not be wasted on ineffectual therapies and treatments. While much healthcare has reasonable evidence of benefit, there is still too much that does not. Health research needs more funding to identify better and more efficacious therapies. What is also needed is an end to funding of therapies on the NHS that have been shown to be ineffective – homeopathy is just one such “therapy”. The House of Commons Committee on Science and Technology was pretty clear in its recommendations:-
    http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4502.htm
    Given that the total spend on homeopathy in the NHS is small and shrinking year on year, it’s hardly a top priority of successive governments to make a decision on homeopathy funding as the primary concerns of MP’s is to get re-elected. Closing any hospital is political suicide – you can only do so by providing something to replace it. I don’t see any sign of any politicians recommending that new homeopathy/CAM hospitals are built. Oh sorry, I forgot about David Tredinnick – shame that few people regard his pro-homeopathy opinions as being valid. There are many reasons to be disgruntled with politicians, such as the parliamentary expenses scandal. Small wonder that MPs rank with corporate bankers as being top of the list of the most untrustworthy people in society. However, most people will still cast their votes on other issues – single issue parties never do well as those issues are rarely of sufficient magnitude to attract the interest of the voter.
    I suspect that the majority of the UK population still really don’t understand homeopathy, a situation not helped by national newspapers discussing health topics so awfully. Raising public awareness through the Sense About Science and the 10:23 campaigns is essential to awaken the public to the pseudoscience that permeates throughout the CAM industry. When – and only when – MPs start acting on evidence rather than appealing to popularity and reacting in knee-jerk fashion to events, then they will make informed decisions about how to spend taxpayers money.

    • Dr. Kaplan October 3, 2011 at 9:15 pm

      HI Paul,
      I’m not angry but we must accept that we are lightyears apart in what we understand as democracy. People are entitled to vote for whom and what they want – whether the evidence for whatever they vote for satisfies your criteria, mine or Richard Dawkins.
      Take Germany for example: One of the largest political parties there is the Christian Democrats. Although there is no hard ‘evidence’ for Christianity, people are entitled to vote for the Christian Democrats and many do. We also see many Islamist governments actually voted for. We may or may not like it, but it does happen. Problems occur when that Government abandons democracy and the people don’t get another chance to vote – as has happened in many situations in the world.
      You are fully entitled to your views on NHS homeopathy, but I do not believe you are in a better position than a patient’s personal GP to decide whether they should be referred to an NHS homeopathic doctor. That is my main point and perhaps my only point. By all means try to convince referring GPs not to send patients for NHS homeopathy if that is what you conscience says you should do. But to try to get homeopathy off the NHS by legislation is going to far. You need to respect democracy and the views of significant minorities much more.
      As Winston Churchill said: ‘The best argument against democracy is a five minute conversation with the average voter’. Nevertheless he was a great democrat as he knew that all alternatives to it were horrific.
      Patients and taxpayers are well protected by UK GPs in this issue. Bombard GPs with anti-homeopathic propoganda if you must but know that to THWART rather than dissuade them is to undermine liberal democracy itself – a very, very dangerous thing to do. There is more than homeopathy at stake here.

  28. Ycvddgdf October 4, 2011 at 5:29 am

    2011…

    You really make it seem so easy with your presentation but I find this matter to be really something that I think I would never understand. It seems too complex and very broad for me. I’m looking forward for your next post, I’ll try to get the hang of…

  29. ce qui est vimax October 4, 2011 at 12:25 pm

    Just wanted to say your Blog is in my rss you got a way with words.. Cheers,
    Acheter vimax en France.2011AVEF

  30. Andrew Sikorski MBBS MRCGP MFHom October 4, 2011 at 12:33 pm

    As an NHS GP I have been thwarted from making a free choice of prescribing what I want by our medicine managements team who are tasked with reducing the NHS drugs bill spend. Interestingly there is no quible with the prescribing of cheap, effective homeopathic and herbal medicines such as Cratageus- hawthorn- which has a Cochrane collaboration report supporting its use alongside conventional treatments for congestive cardiac failure. Shame Ernst hasn’t been banging on about wider use of this great drug which allows patients, who previously couldn’t, to walk more easilly without horrendous, suffocating shortness of breath which was the case on their purely conventional cocktail of medicines. Shame people can’t see the wider picture due to their blinkered perspective, but then again when I’ll be visually impaired I won’t notice the dust and cobwebs gathering either.

    • Dr. Kaplan October 4, 2011 at 1:04 pm

      Yes indeed Andrew. The S&T Committee’s recommendations were hugely devalued by the fact that only 3 of the original 14 members actually signed the report, showing real contempt for the process. Who are these people who think they know better than a patient’s GP what’s good for that particular patient? Quite incredible. Look at the reaction to my comment that the campaign is ‘seemingly well-funded’, a comment I stand by, because it ‘seems to me’ to be that way. I stated what something looked like to me: eg: if someone says ‘The princess’s dress seemed very expensive-looking’. The fact that it cannot be proved does not mean the dress is not expensive. A case of “The lady doth protest too much, methinks” ? Me thinks so.

  31. Paul Morgan October 4, 2011 at 9:49 pm

    I wondered how long it would be until Dr. Sikorski joined in. Perhaps he would be good enough to provide credible evidence as to the claimed efficacy of homeopathy. Talking about herbal “remedies” is an unwarranted distraction as many herbal “remedies” contain highly active ingredients – some are beneficial (if uncontrolled) while others are positively dangerous. If you are going to claim a therapy is effective, please provide a complete reference. However, let’s stick to homeopathy. He uses the terms “cheap” and “effective”. Here I have a problem. Firstly, my primary concern is efficacy. No-one here (or indeed on many other discussions I have been involved with on homeopathy) has presented any evidence showing homeopathy to be beneficial for any disease process over and above a placebo effect or regression to the mean. Thus, irrespective of any purported incredulous mechanisms of actions for homeopathy, there is a credibility problem for efficacy – homeopathy is not efficacious. This leads on to the second issue of cost. Sikorski claims homeopathy is cheap. Oh dear. The cost of a drug in relation to its efficacy is reasonably straightforward. Let’s consider, for example, an antibiotic. Efficacy is reasonably straightforward to determine through the clinical trials process – cure rates of a certain percentage can be compared to placebo (almost certainly unethical unless no treatment previously existed) or a current established antibiotic. If current treatment “X” has a cure rate of, say, 60% but new treatment “Y” has a cure rate of, say, 75% it is likely that treatment “Y” is superior to “X”, provided that the trial(s) were large enough (i.e. of sufficient power) to make such a measured difference real as opposed to chance. If “Y” really is better than “X” then the cost is of secondary concern, providing it’s not ridiculously more expensive. If “X” and “Y” are of equal efficacy, cost is a key issue as clearly the cheaper treatment. Adverse effect profiles might have a bearing on choice of “X” or “Y” if – to take an extreme example – “Y” cures 75% but directly kills 15% of treated patients. In that situation the risk-benefit analysis changes dramatically. Of course, adverse effect profiles is an area with homeopathic “remedies” have the advantage – they have no adverse effects because they have no effects! What about cost? OTC homeopathic remedies available at Boots cost between about £4.10 and £6. The cost of the raw ingredients (sugar pilules, water, sometimes ethanol) is negligible. The “active ingredients” are non-existent, having been diluted beyond the point where the likelihood of finding a single molecule of the “active ingredient” is so remote that I have a greater chance of winning the National Lottery five weeks running (30C dilution – a standard dilution). At 12C dilution, Avogadro’s Limit is passed. This is incontrovertible. So it’s back to the sugar pilules. A 20kg bag of pilules costs around £200. 88 pilules (weighing just a few grams) of whatever costs around £5.50 in Boots. 20kg is many thousands of pilules! Fine silver today sells at about 54 pence per gram.
    Thus, we have ineffective “remedies” that cost more than fine silver. Cost-benefit analysis? Staggeringly costly as there’s no benefit. Risk-benefit analysis? On the face of it, with no adverse effects homeopathy looks good in terms of risk – lack of proven benefit, however, is still a major problem. But, of course, homeopathy is not without risk as it may divert patients away from real therapies of proven efficacy. http://whatstheharm.net/homeopathy.html details many cases where homeopathy has resulted in significant harm and even death. This site doesn’t even mention probably the most shockingly awful case, that of Penelope Dingle in Australia. Here’s a link to the Coroner’s report:-
    http://www.safetyandquality.health.wa.gov.au/docs/mortality_review/inquest_finding/Dingle_Finding.pdf
    Very few people, and in particular most doctors, are capable of assessing evidence of efficacy for therapies adequately – personal experience is fraught with observer bias. Many trials are not of sufficient power to adequately assess efficacy in a definitive manner. In the absence of such trials, the best we can do is a proper meta-analysis. For homeopathy, there are no trials of adequate power or methodology that show a benefit for homeopathy. For homeopathy, the highest quality meta-analyses show no benefit. If doctors themselves cannot determine efficacy adequately, then the best available evidence should be used. In which case, the NHS should stop funding homeopathy.

    • Dr. Kaplan October 4, 2011 at 10:20 pm

      Dear Paul,
      There is so much to disagree with in your missive but I’ll just make it clear that I do not agree that “For homeopathy, the highest quality meta-analyses show no benefit” I don’t consider Shang high quality and many agree with me. We believe that there are many trials and meta-analyses that do show homeopathic efficacy and you can find these on the website of the Faculty of Homeopathy. The issue is by no means cut and dried. It really is an issue of we have our meta analyses and you have yours with each side accusing the other of cherry picking and that is the truth of it.
      Also regarding your last note: I fully stand by my statement that the campaign against homeopathy is ‘seemingly well funded’. It certainly seems that way to me, but unlike others I am not going to name names without absolute definitive proof – and Wikipedia is not absolute proof. However lack of cast iron proof does not mean it does not exist. So I’ll stick with ‘seemingly well funded’. That is not an allegation; it is what it seems like to me. ie a personal opinion.
      Regarding homeopathy being dangerous: What nonsense. NHS homeopathic doctors are fully accountable for their actions.
      Please remember that this post is about HOMEOPATHY, POLITICS and LIBERTY not controlled trials.
      The campaign against homeopathy is deeply disingenuous when it says that money is wasted on homeopathy on the NHS. Just look at the bill for SSRIs and what Kirsch et al have to say about using SSRIs in moderate and mild depression. I don’t see a campaign to THWART GPs from prescribing SSRIs with a budget of 232m as opposed to homeopathy’s 10m. Incredible hypocrisy.
      And you have never addressed my point: You can’t see a homeopathic doctor on the NHS without a referral from your GP. So why don’t you canvass GPs with your propaganda instead of unsuccessfully trying to undermine democracy. Nothing you have said has changed the obvious inference that any reader can make of our conversation:

      I trust the GPs of our National Health Service more than you do.

      I trust them to make the best decisions to benefit their patients including sending them to other fully qualified homeopathic doctors on the NHS. You would THWART them rather than dissuade them. In other words your politics are by inference authoritarian while mine are libertarian.

  32. Andrew Sikorski October 7, 2011 at 12:42 am

    SOme people appear to have their x and Y crossed- abc is safer. X for playtex bra and Y for y-fronts? Who mentioned twisted knickers? The reams published on inappropriate antibiotic prescribing indicate these lovely sweet pink(for strawberry) and yellow ( for banana) gloopy products designed with oodles of optimal multi-sensory placebo enhancement are regularly prescribed when not indicated, but demanded by patients who attend surgeries in droves looking for an elixir to remedy their sore: throat; ear; teeth; cough- and get them and go away happy and sometimes come back requesting a ‘stronger’ antibiotic when their viral infection persists. You see patients often know what is best for them- what they want to help them get better- their expectation of the encounter is paramount. Woe betide the clinician who tries to get between an ill child’s mother and their ‘wonder drug’. Antibiotics have been, on the whole, pretty safe so dishing them out (whilst sub-optimal EBM) is a safe NHS-wide placebo practice with satisfied customers, producers happy with the cash chinking in their pockets and a few public health consultants and microbiologists gnashing their teeth and having to design newer and yet more expensive product to ‘kill the resistant strains’. Some people really ought to study medicine and then practice it for a decade or so before throwing sweeping statements which leave them open to slipping up on their own recently tossed banana skins. I do wonder how long before anyone re-enters the fray to further this enthralling debate?

    • Dr. Kaplan October 7, 2011 at 10:20 am

      Although nobody can doubt the inherent philanthropism and self-evident altruism of the ‘some people’ to which you refer, it is interesting that have no interest in commenting on:
      1. the prescription of ‘unnecessary anti-biotics’ for likely viral infections.
      2. the prescription of SSRI (at huge cost) for mild and moderate depression which a major meta-analysis shows that they are no better than placebo.
      3. the huge swathes of conventional and commonly used treatments that have no evidence behind them whatsoever.

      I guess there will always be people that in healthcare (and all other matters) will seek ways of trying to bypass democracy to change society according to what only they ‘know’ is best for the people. The political philosophy of people who seek to make their personal views trump democracy can be summed up in one statement that they should make the motto: ‘We know better than you what’s good for you!’

      Let us never forget the words of Wayne LaPierre: ‘Freedom is never an achieved state; like electricity, we’ve got to keep generating it or the lights go out.’– Wayne LaPierre

  33. Andrew Sikorski MBBS MRCGP MFHom October 7, 2011 at 11:19 am

    Brian I utterly agree with you ‘some people’, indeed all people, are lovely amazing intricate creations whom we can call brothers and sisters and to whom unconditional love and understanding with support and positive feedback can be offered to. There remains the fundamental right to disagree with them when there is a thrust to create and enhance the false perspective of ‘them and us’- I welcome the great success there has been in reducing homeopathic practice nationally by three quarters- haven’t they done well!?

    • Dr. Kaplan October 7, 2011 at 3:54 pm

      Yes indeed Andrew they have. For a bunch of people with no vested interests (‘other than intellectual and humanitarian interests’ as Andy Lewis has pointed out in a comment above) and certainly not ‘well funded’ (as Paul Morgan has made emphatically clear, also in a comment above) their propaganda, effective PR and the acquisition of powerful (eg the BBC) and less-than-powerful but still influential friends (eg The Guardian) has yielded practical results as most powerful propaganda campaigns often do.

      The whole point of this post is that at the level of pure politics they have failed. The notorious S&T Committee (signed by only 3 of a possible 14 signatories) was their attempt to win in the realm of pure politics and for them this was indeed a bridge too far and they suffered severe, humiliating and infuriating (cf. Michael Baum’s ranting letter to The Lancet) defeats. I almost felt sorry for them at the time because we both know that these authoritarian philanthropists and altruists are donating their time and efforts purely for the benefit of the public (presumably because they don’t trust the man in the street – nor his GP! – to know what is good for him.)

      At this point in time however, it is clear that in the realm of official politics it is the opinion of the Labour Party, The Coalition and The Queen (who has always used it and gave her name to the Royal London Homeopathic Hospital and its successor The Royal London Hospital for Integrated Medicine) that homeopathy is worthwhile and that the people should have access to it on the NHS.

      That was the only point of this post.

  34. Andrew Sikorski MBBS MRCGP MFHom October 7, 2011 at 4:34 pm

    Good point. Good to debate. Well done!

Comments are closed.