MD, PhD, FMedSci, FSB, FRCP, FRCPEd

As mentioned several times on this blog, homeopathy lacks a solid evidence base (to put it mildly). There are powerful organisations which attempt to mislead the public about this fact, but most homeopathy-fans know this only too well, in my opinion. Some try to bypass this vexing fact by trying to convince us that homeopathy is value for money, never mind the hard science of experimental proof of its principles or the complexity of the clinical data. They might feel that politicans would take notice, if homeopathy would be appreciated as a cheap form of health care. In this context, it is worth mentioning that researchers from Sheffield have just published a systematic review of economic evaluations of homeopathy

They included 14 published assessments in their review. Eight studies found cost savings associated with the use of homeopathy. Four investigations suggested that improvements in homeopathy patients were at least as good as in control group patients, at comparable costs. Two studies found improvements similar to conventional treatment, but at higher costs. The researchers also noted that studies were highly heterogeneous and had numerous methodological weaknesses.

The authors concluded that “although the identified evidence of the costs and potential benefits of homeopathy seemed promising, studies were highly heterogeneous and had several methodological weaknesses. It is therefore not possible to draw firm conclusions based on existing economic evaluations of homeopathy“.

Thre are, of course, several types of economic evaluations of medical interventions; the most basic of these simply compares the cost of one medication with those of another. In such an analysis, homeopathy would normally win against conventional tratment, as homeopathic remedies are generally inexpensive. If one adds the treatment time into the equation, things become a little more complex; homeopathic consultations tend to be considerably longer that conventional ones, and if the homeopaths’ time is costed at the same rate as the time of conventional doctors, it is uncertain whether homeopathy would still be cheaper.

Much more relevant, in my view, are cost-effective analyses which compare the relative costs and outcomes of two or more treatments. The results of such evaluations are often expressed in terms of a ratio where the denominator is a gain in health from a treatment and the numerator is the cost associated with the health gain. The most common measure used to express this is the QUALY.

Any cost-effective analysis can only produce meaningfully positive results, if the treatment in question supported by sound evidence for effectivenes. A treatment that is not demonstrably effective cannot be cost-effective! And this is where the principal problem with any cost-effectiveness analysis of homeopathy lies. Homeopathic remedies are placebos and thus can be neither effective nor cost-effective. Arguments to the contrary are in my view fallacious.

The authors of the new article say they have  identified evidence of the potential benefits of homeopathy. How can this be? They based this conclusion only on the 14 studies included in their review. But this is only about 5% of the total available data. Reliable estimates of effectiveness should be based on the totality of the available evidence and not on a selection thereof.

I therefore think it is wise to focus on the part of the authors’ conclusion that does make sense: ” It is… not possible to draw firm conclusions based on existing economic evaluations of homeopathy“. In plain English: economic evaluations of  homeopathy fail to show that it is value for money.

28 Responses to Is homeopathy value for money?

  • Homeopathy works QED
    Whether it works by active medication or suggestion may even be besides the point. Outcome studies show this repeatedly eg the one in Bristol. Patients are interested in outcome more than anything else and who can blame them. Homeopathy has been used by every stratum of society in England for 200 years and represents exceptional value for money because it really does work. If you think that it works because of sympatico conversations then even then it is good value because homeopaths charge very little for spending a lot of time with their patients – as their art requires.

    • the QED is most impressive and ALMOST convinced me!
      I am glad you mentioned the Bristol study; did you you know that most patients also received conventional treatments?

      • Yes, Professor Ernst I did indeed know that. I understand that the doctors working at the Bristol Homeopathic Hospital are not only qualified in homeopathy but are registered MDs. By offering the best of both conventional and homeopathic medicine, they are clearly dedicated to getting the best results for their patients with all tools at their disposal. What is important to realise about this trial is that all these patients were not getting better on conventional medicine alone – that is why their GPs sent them to doctors who use both conventional and homeopathic medicine as all good homeopathic doctors should do. The Bristol Homeopathic Hospital is a CLINIC – not a research project and in that regard there is nothing wrong with doing an ethical outcome study like this one which did indeed show that patients with refractory problems benefited from attending an NHS homeopathic clinic. QED in the trial.

        • Loverov Freedom said:

          By offering the best of both conventional and homeopathic medicine…

          First, show that homeopathy is a medicine.

        • without a control group, how can you know that “ALL THESE PATIENTS WERE NOT GETTING BETTER ON CONVENTIONAL MEDICINE ALONE”? you cannot even be sure that the results were due purely to the natural history of the condition.
          correct, there is nothing wrong with an outcome study – except if someone makes causal interences on the basis of the results.

          • If they were getting better on conventional medicine alone, they would surely have got better on thes standard treatment offered by their GPs. Remember these are cases who were not getting better on conventional treatment – the main reason these patients get referred to homeopathic specialists by their GPs.

            This leaves 3 possible reasons for their improvement at the homeopathic clinic:

            1. Homeopathic medicines are clinically active and effective
            2. Visiting a homeopathic doctor and having your history taken in the homeopathic way by doctors who believe that 1. is true – leads to a positive therapeutic effect. This means a referral to the Bristol Homeopathic clinic is good for patients – no mattter how anybody thinks homeopathic medicine works.
            3.Homeopathic NHS doctors are better prescribers of conventional medicine than NHS GPs.

            You can take your choice, but whatever that choice is it will still never ever, ever support closing down an effective NHS clinic like the Bristol Homeopathic Hospital or any other NHS homeopathic clinic in the country. How long is it going to take you to assmilate this simple fact, Prof. ? Time to put patients ahead of ideology?

    • Loverov Freedom said:

      Homeopathy works QED

      I don’t think you know what that means.

      Whether it works by active medication or suggestion may even be besides the point.

      It is very much the point. But first, show that it does work and suggest a plausible mechanism of action. (Explanations using sciency-sounding words/phrases that don’t stand up to scrutiny don’t count.)

      Outcome studies show this repeatedly eg the one in Bristol.

      The Bristol ‘study’ was a customer satisfaction survey that did not measure treatment outcomes. It did not show that customers’ perceived improvement was due to any sugar pills they might have taken. I’d prefer health decisions to based on something a good bit more solid than marketing surveys run by those with vested interests, wouldn’t you?

      Patients are interested in outcome more than anything else and who can blame them.

      Fortunately, doctors and scientists aren’t content with such things and want to know if something really, really does work, not just that someone thinks it works. And it needs some care and attention paid to details such as bias – inadvertent or otherwise – before jumping to the conclusion it was the sugar pills wot done it. I suggest you read about expectation and experimenter bias – Wikipedia has a good introductory article on it.

      Homeopathy has been used by every stratum of society in England for 200 years and represents exceptional value for money because it really does work.

      If it doesn’t work, then it is of no value, no matter how cheap the sugar pills are. And you’ve not provided one jot of good evidence that homeopathy does work. The rest of your ‘argument’ consists of two logical fallacies: ad populum and an appeal to antiquity. I hope you can see why these are not in the slightest bit persuasive?

      If you think that it works because of sympatico conversations then even then it is good value because homeopaths charge very little for spending a lot of time with their patients – as their art requires.

      There is little doubt that some find a sympathetic ear helpful (although how useful a discussion of medical things with someone who is not medically trained is a moot point), but to then go and sell some sugar pills saying that they will help when there is no good reason to think that’s the case is called lying and is unethical.

      • Homeopaths believe that their medicines work and thus do not lie to anyone. The fact that you don’t agree does not mean that they are lying. Perhaps you also think that the Pope, the Archbishop of Canterbury and any other religious leader in the world is also lying because you can think of ‘no good reason to think’ that a divinity exists? People who don’t agree with your deterministic view of the universe may seem to be naive to you – but that is the worst you can accuse them of.

        • Loverov Freedom said:

          Homeopaths believe that their medicines work and thus do not lie to anyone. The fact that you don’t agree does not mean that they are lying. Perhaps you also think that the Pope, the Archbishop of Canterbury and any other religious leader in the world is also lying because you can think of ‘no good reason to think’ that a divinity exists? People who don’t agree with your deterministic view of the universe may seem to be naive to you – but that is the worst you can accuse them of.

          Straw man. I never said homeopaths were liars.

          I also don’t rely on what homeopaths ‘believe’. Our beliefs can be wrong, which is why we have to very carefully test things to see whether those beliefs are, in fact, correct. Homeopaths have yet to show their beliefs are founded in good evidence.

          And my views on any religious leader is irrelevant to this discussion – unless they too make claims for homeopathy that are not based on good evidence?

        • BRAVO!
          i agree entirely; if we see homeopathy as a religion, you are correct. if we see it as health care, we have to insist on proper proof. if proof is missing, the treatment is unproven and claims are bogus. that seems to be the case for homeopathy.

          • Many homeopathic commentators have made the simple point that a substantial number of people want NHS homeopathy and as long as it is prescribed by NHS doctors, they should get it in a democratic country just like they want a Queen and Church of Engand. People like you and Richard Dawkins are welcome to offer them something else and stand for election and see how you do. The reason that the Government always backs NHS homeopathy is not because of the rather inane suggestion that some make, that it is somehow connected to Prince Charles. It is simply because all political parties see that there is a SUBSTANTIAL MINORITY of people in the UK who want NHS homeopathy and will be antagonised by a party that would withold it from them That
            is how democracy works Prof. If you do not like it, there is always Stalinism but I do not think we are quite ready to elect a Stalinist partyi just yet. Maybe soon though

        • Alan, please look at your comment on 15 Feb at 15.17, the last paragraph, fourth last word. I was responding to that when I used the word ‘lying’. So do you take back your insult of calling me a strawman? I would not bet that you would do that because there is no depths that the critics of homeopathy would stoop to in order to try to deny others NHS homeopathy. I am not asking you to believe in anything but I do ask you to admit you were wrong in accusing me of using a strawman argument. I will not be holding my breath for an answer.

          • so you believe health care technologies are to be democratically voted for?
            interesting!!!
            who votes for bone marrow transplants and who against it?
            any votes for or against coronaty bypasses?
            THIS IS FUN – LET’S ALL PLAY PARALLEL UNIVERSE!

          • Loverov Freedom said:

            Alan, please look at your comment on 15 Feb at 15.17, the last paragraph, fourth last word. I was responding to that when I used the word ‘lying’. So do you take back your insult of calling me a strawman?

            I didn’t call you a straw man: it’s the logical fallacy that’s a straw man, not the person making it.

            I would not bet that you would do that because there is no depths that the critics of homeopathy would stoop to in order to try to deny others NHS homeopathy. I am not asking you to believe in anything but I do ask you to admit you were wrong in accusing me of using a strawman argument. I will not be holding my breath for an answer.

            If you had held your breath, you could start to breath again. I did say that selling sugar pills to someone and telling them they will help is lying, but there is some subtlety in what I was trying to say: it is, from the customer’s perspective, being sold a lie, no matter how fervently the homeopath believes it to be true. The same applies to whatever other religious beliefs someone might hold: they are all entirely free to hold those beliefs, but the ethical problems start when they try to sell those beliefs to others, particularly given the power dynamics of a ‘therapeutic’ encounter.

          • Yes, if the public wants NHS qualified doctors treating them with the best conven and homeop medicine, they should get it. Just as they get NHS psychiatry. Ever looked at evidence base for psychotropic drugs Prof? Or is your job to trash CAM and ONLY CAM for lack of evidence that convinces you/
            As for Alan H, I ll take that as an admission that it was wrong to use the term strawman in relation to me or my argument. You used the word ‘lying’ and cannot weasel your way out of this by using the word ‘subtle’

    • Outcome studies show this repeatedly eg the one in Bristol.

      Particularly interesting that you should mention that study in reply to a post about value for money, in view of the follow-up study that was carried out.

      Having found that in the 2005 uncontrolled outcome study “the biggest improvements were seen in children with asthma”, a team from Bristol homeopathic Hospital carried out a controlled (although unblinded) trial of conventional treatment versus conventional treatment plus homoeopathy for children with asthma. The paper, when eventually published, found no significant difference between the groups, or as the abstract of the paper puts it “Evidence in favour of adjunctive homeopathic treatment was lacking”, but found that the treatment of the children treated with homoeopathy cost, on average, £615 more each than the children in the control group.

  • As a (genuine) aside, how should we take this statement in Altunc, Pittler & Ernst (2007): “Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials”:

    “The evidence for ADHD and acute childhood diarrhea is mixed, showing both positive and negative results for their respective main outcome measures.”

    Do we just have to appreciate the entirety of the clinical evidence-base for homeopathy (and its implausibility), and accept random clusters of positive (and negative) results will bubble through now and again; concede there’s clinical evidence for homeopathy in a tiny minority of childhood conditions; or is there an reasonable methodological flaw to these studies that we should be wise to? I genuinely ask, as I’ve been spending this morning looking at ADHD in a range of contexts, and would like to be able to answer criticism that I’m ignoring an inconvenient truth.

    All comments appreciated.

  • our statement about the evidence being mixed is factually correct. why this is so can only be answered by speculation. for the 2 conditions you mentioned, there are only very few studies; they are not particularly poor, if i remember correctly. my money is on PUBLICATION BIAS [negative studies remain unpublished] but ask a homeopathy-fan and you will hear a different speculation to mine.

    • Thanks for the reply Professor. Great that you report the facts as you find them (as is/was your job). Yes, I stupidly hadn’t considered publication bias as a fourth option. It’s entirely plausible to me now that these positive studies would be drowned out by a great deal more negative studies were we looking at the entire evidence base – but like you say, speculation.

  • There is a fundamental confusion between naturopathic and homeopathic. Homeopathic remedies are not remedies per se as in naturopathic plant based potions aimed to address symptoms. Homeopathic is treating ‘like with like’. In other words, if one is experiencing ‘acidity’ the homeopath, after consideration, will try to duplicate this effect and may prescribe, for example, arsenic in tiny doses. The effect of this is to galvanize the body defense mechanisms. Then the homeopath addresses the evacuation of toxins. There are several stages to the process.

    It is probably impossible to measure as it takes a long time for the body to reassert it’s health.

    • no confusion at all!
      we all know the difference – and we also know that your assumption (impossible to measure) is utterly wrong.

      • “There is a fundamental confusion between naturopathic and homeopathic.”
        “no confusion at all! we all know the difference”

        I wish that were true! I cannot count the number of conversations I’ve had with people who mistakenly think homeopathic is an umbrella term for everything not pharmacological.

        I’m quite certain this confusion is encouraged by the homeopathy quacks to acquire credibility for their sugar and water preparations by association, in people’s minds, with non-pharmacological preparations that actually do work. Creams and pills that actually contain, say, arnica can be effective; water that once had a passing acquaintance with an arnica molecule and was then whacked 10 times against leather and horsehair is not.

        • Naturopaths use homoeopathy (along with a wide variety of other unproven therapies), so confusion around this is not unlikely.

          I find that people more often confuse homoeopathy with herbal medicine. It sometimes takes quite some time to convince people that I’m not joking when I explain to them what homoeopathy actually involves.

  • NHS Coices have just changed their view on homeopathy: NO EVIDENCE FOR EFFECTIVENESS!!!
    http://www.nhs.uk/Conditions/homeopathy/Pages/Introduction.aspx#evidence

  • Loverov Freedom:
    in addition to the possibilities you outlined above there are other reasons for improvement:
    natural history of disease
    concommittant treatments not declared
    social desirability
    pleacebo-effect…to name just the most obvious

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