MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The Royal Australian College of General  Practitioners (RACGP) just issued an important statement on homeopathy which, in several ways, goes beyond previous announcements on this subject. I take the liberty of reproducing it here in full:

The RACGP supports the use of evidence-based medicine, in which current research information is used as the basis for clinical decision-making. In light of strong evidence to confirm that homeopathy has no effect beyond that of placebo as a treatment for various clinical conditions, the position of the RACGP is:

1. Medical practitioners should not practice homeopathy, refer patients to homeopathic practitioners, or recommend homeopathic products to their patients.

2. Pharmacists should not sell, recommend, or support the use of homeopathic products.

3. Homeopathic alternatives should not be used in place of conventional immunisation.

4. Private health insurers should not supply rebates for or otherwise support homeopathic services or products.

Background

The contention that homeopathy is an effective treatment is not supported by evidence from systematic literature reviews. The National Health and Medical Research Council (NHMRC) analysed the scientific evidence for the effectiveness of homeopathy in treating a range of clinical conditions and released a position statement [1] in March 2015. The NHMRC’s review concluded homeopathy does not produce health benefits over and above that of placebo, or equivalent to that of another treatment.[2] Crucially, the report states that there are “no health conditions for which there is reliable evidence that homeopathy is effective” as a treatment.

While not covered in the NHMRC’s review, it is also the case that homeopathic alternatives to conventional vaccination do not prevent communicable diseases or increase protective antibodies to disease. The National Centre for Immunisation Research and Surveillance has advised that there are no studies of sufficient quality to demonstrate the safety or effectiveness of ‘homeopathic vaccines’ for protection against disease.[3] Indeed, there is no plausible biological mechanism of action by which these products could prevent infection.[4]

Harms associated with homeopathy

Homeopathic products are sometimes considered harmless as they are generally administered at a high dilution. Some may not even contain a single molecule of the original source material. However, there are a number of risks associated with the use of homeopathy.

Delaying or avoiding conventional medical care

When the use of homeopathy causes a person to delay or avoid consultation with a registered medical practitioner or reject conventional medical approaches, serious and sometimes fatal consequences can occur. As evidenced by recent Australian court findings, spurious claims made by homeopathic practitioners[5] and retailers[6] can mislead individuals about the effectiveness of conventional medicine. When homeopathic vaccines are used as an alternative to conventional immunisation, both the individual and the community are left exposed to preventable diseases.

Problems associated with unregulated products

Although homeopathic products manufactured in Australia are regulated as medicines under the Therapeutic Goods Act 1989, products sold on international websites may not meet Australian quality and safety standards. These products may be of particular concern when materials from problematic sources are employed in the preparation (e.g., pathogenic organs or tissues; causative agents such as bacteria, fungi, parasites, ova, yeast, and virus particles; disease products; excretions or secretions; heavy metals and toxins such as aconitum, kerosene and thallium). Impurities of source material and contamination associated with poor manufacturing processes also present threats to the quality and safety of these products.[7]

Direct adverse effects

Various direct harms associated with the use of homeopathic products have been noted in the literature, including allergic reaction, drug interactions, and complications related to the ingestion of toxic substances.[8]

The importance of patient-centred practice

The RACGP supports the concept of patient-centred practice, in which the values, preferences, and personal healthcare philosophy of the patient are respected and individuals play an important role in their own healthcare. An estimated six per cent of Australians use homeopathy over the course of a year.[9] It is important that these patients feel comfortable in discussing their use of complementary and alternative medicines with all members of their treatment team.

It is good practice for medical practitioners to initiate conversations with patients about their use of or intention to use homeopathy, and assist patients to think critically about the efficacy and safety of homeopathy so that they may make informed healthcare decisions.

Private health insurance and homeopathy

Many private health insurers provide ancillary (extras) cover that subsidises homeopathic treatment, and the individual’s costs in taking out this cover are subsidised under the Australian Government’s private health insurance rebate. The RACGP is concerned that health insurance premiums continue to rise as funds disburse significant sums for the use of homeopathy and other natural therapies lacking rigorous evidentiary support. In the 2013–14 financial year, health insurers paid out $164 million in benefits for natural therapies, up by almost 60 per cent from 2010–11.[10]

The RACGP also notes that offering subsidies for the use of homeopathy sends a confusing message to consumers. Listing homeopathic treatments alongside evidence-based modalities in a list of member benefits lends legitimacy to a practice that is not supported by scientific data.

References

1. National Health and Medical Research Council. NHMRC Statement: Statement on Homeopathy. Canberra: NHMRC; 2015.

2. National Health and Medical Research Council. NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions. Canberra: NHMRC; 2015.

3. National Centre for Immunisation Research and Surveillance. Homeopathy and vaccination [fact sheet].2014 [cited 2015 April]. Available from http://www.ncirs.edu.au/immunisation/factsheets/homeopathyvaccination-
fact-sheet.pdf

4. Commonwealth Department of Health and Ageing. Myths and realities: Responding to arguments against vaccination. A guide for providers. Canberra: DoHA; 2013.

5. Coronial inquest into the death of Penelope Dingle. State Coroner of Western Australia, 2010.

6. Australian Competition and Consumer Commission v Homeopathy Plus! Pty Ltd. FCA, 2014.

7. World Health Organization. Safety issues in the preparation of homeopathic medicines. Geneva: WHO; 2009.

8. Posadzki P, Alotaibi A, Ernst E. Adverse effects of homeopathy: a systematic review of published case reports and case series. International Journal of Clinical Practice 2012 Dec;66(12): 1178–88.

9. Xue CCL, Zhang AL, Lin V, Da Costa C, Story DF. Complementary and alternative medicine use in Australia: a national population-based survey. Journal of Alternative and Complementary Medicine 2007; 13(16):643–50.

10. Private Health Insurance Administration Council. Operations of the Private Health Insurers Annual Report 2013–14. Canberra: PHIAC; 2014.

I think this is a very good statement:

  • it is based on the best evidence currently available,
  • it is concise and to the point,
  • it covers all the necessary ground,
  • it provides valuable and practical recommendations.

Perhaps I should mention that it came as a complete surprise to me, and I was not involved in any way.

Finally, I would like to express my hope that this statement will be adopted in Australia and send a powerful signal to organisations across the world to issue similar recommendations for the benefit of vulnerable patients who still fall victim to bogus claims by homeopaths every day.

11 Responses to A further strong nail in the coffin of homeopathy

  • We need UK GPs to do the same.

  • Beautiful. Next step: attaching some genuinely painful consequences to violating one or more of those 4 principles.

  • It is past time that the FDA in the United States supported these resolutions as well. Unfortunately, our politicians (who are not representatives) couldn’t care less.

  • Excellent. And yes, let’s see the BMA and RCGP adopting similarly robust positions. It is time for this quackery to stop: doctors dabbling in homeopathy is as inappropriate as creationists working for the Natural History Museum.

    • I have submitted the following motion to be debated at the BMA Annual Representative Meeting (Liverpool, 21-25 June 2015):

      “250. Motion by SOUTH DEVON DIVISION: That this meeting:-
      i) notes that BMA past president HRH the Prince of Wales “Believes in combining the
      best of evidence-based, conventional medicine, with a holistic approach to healthcare;
      treating the whole person rather than just the symptoms of disease.” (Spokesman,
      Daily Telegraph 21st January 2015);
      ii) reassures HRH that the best conventional medicine already incorporates holistic
      approaches;
      iii) requests that HRH publishes any evidence he has that homeopathic remedies are
      capable of outcomes any better than can be achieved by declared placebos.”

      Unfortunatlely the Agenda Committee has placed this motion down the Agenda and it won’t be discussed!
      Still, it is there, and if the Dail Mail spots it they might comment and lead the BMA to revise its stance (which is one of burying its head in the sand and hoping I will go away).

      Current BMA policy is that no funds should be spent on homeopathic remidies ‘unless and until NICE reports on their value’. I concentrate on the remedies – which are sold in a manner which might be fraudulent. If folks want to spend an hour with an empathic homeopath having some TLC let us be honest about that relationship and its purpose.

      So, in order to make progress the public media must become engaged and push the BMA (and our RCGP/RCP) to be more active in ensuring patients are properly informed. They might like to buy a copy of my forthcoming book ‘Real Secrets of Alternative Medicine’. Better still, subscribe to this blog!

  • On one hand homeopathy is no better than placebo. On the other hand it can interfere with other drugs or cause allergic reactions. How can both be true? Also the reason some patients don’t like to mention the use of homeopathic or other alternative or natural approaches is because of the way they are treated or talked down to by their GPs or specialists.

    • most but not all homeopathic remedies are highly diluted. therefore some can interact. simple!

      • A ‘pure’ homeopathic remedy will do nothing (unless the patient overdoses on lactose).
        But not all products sold as ‘homeopathic’ are pure and adulteration makes some have untoward effects.
        Some have been shown to contain toxic heavy metals.

    • Indeed, people who use homeopathy and other kinds of quackery hate to be told the truth, especially by people who are medically qualified. However, ethically that’s what doctors have to do.

    • About Murray Feldman,
      While Murray was honest enough to use his own name, he wasn’t quite honest enough to say who (or what) he is. If this is the same person (and I have little doubt it is), Murray has been in this caper, homeopathy, for 38 years, according to this link;
      http://www.wchs.info/murfel

      According to this page,
      http://www.wchs.info/about-homeopathy/about-homeopathy,
      “… can produce dramatic improvement in acute conditions (e.g., viral infections, physical injuries) by significantly reducing the intensity of symptoms and recovery time.”
      “Many common children’s complaints, such as bedwetting, colic, diaper rash, earaches, nosebleeds, and teething, also respond remarkably well to homeopathy.”
      “Homeopathic treatment can be particularly useful in deep-seated, chronic conditions that have developed over a long period of time, frequently accompanied by a general deterioration of health. These include almost all well-known medical conditions – from acne, anxiety attacks, arthritis, and asthma to ulcers, varicose veins, warts, and yeast infections – to name a few. Many women find that homeopathy brings great relief during pregnancy and with menstrual irregularities, PMS, and menopause symptoms.”

      Now Murray is studying Hakomi, one of the Somatic Psychology “fields” which is premised on;
      “Ultimately the body will rebel. Even if it can be temporarily pacified with the help of drugs, cigarettes or medicine, it usually has the last word because it is quicker to see through self-deception than the mind. We may ignore or deride the messages of the body, but its rebellion demands to be heeded because its language is the authentic expression of our true selves and of the strength of our vitality.”

      One of his colleagues says this;
      “Homeopathy is simple. All you have to do in your consultation is perceive something from nature in your patient. You can hear it in their story, see it in their actions, and sometimes you witness it appearing in the space between you and them. That is the remedy they need, and if it is the right one, wonderful things can occur after you give it. This extraordinary phenomena is something a homeopath can witness every day. Homeopathy not only connects you to your patient, but to nature too.

      Geoff Johnson, Teacher”
      Is this the 70s, a big lovefest?

      This gets wackier and wackier.

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