MD, PhD, FMedSci, FSB, FRCP, FRCPEd

I have previously reported about the issue of homeopathy on the NHS in Liverpool here. Since then, the NHS Liverpool Clinical Commissioning Group (CCG) has conducted a consultation on whether to continue funding. Personally, I think such polls are a daft waste of resources.

Why?

I will explain in a moment; first read the (slightly shortened) summary:

In November 2015, NHS Liverpool CCG Governing Body stated a preference to decommission the homeopathy service and commenced the consultation exercise with the intent to ascertain how the public felt about it. This report was written by the Centre for Public Health, Liverpool John Moores University, and includes independent analysis of the consultation activities.

The consultation ran from 13th November – 22nd December 2015. The two main methods used were 1) a survey available online and in paper format. It was completed by 743 individual respondents and, of those who provided a valid postcode, 68% (323 individuals) lived within the Liverpool CCG area, 2) a small consultation event held on 4th December 2015 facilitated by Liverpool John Moores University. The event was attended by 29 individuals, the majority of whom were patients and staff from the Liverpool Medical Homeopathic Service. Eighteen of the participants at this event resided in Liverpool.

Two thirds of survey respondents (66%; 380 respondents) said they would never use homeopathy services in the future. The reasons for this included the lack of evidence and scientific basis of homeopathy; negative personal experiences of homeopathy; and believing it was an inappropriate use of NHS funding. Those who would be likely to use it in the future (28%) felt they wanted to be able to choose an alternative to conventional medicine; felt it was value for money for the NHS; appreciated the time, care and holistic consultation; and discussed their own positive experiences. Sixty six per cent of survey respondents (111) who had used homeopathy in the past reported an excellent or good experience. Those who reported a positive experience (66%) felt that homeopathy had improved their health where conventional medicine had not, and participants valued that the homeopathic practitioner had treated their emotional as well as their physical needs. Those who reported a below average or poor experience (31%) felt homeopathy had not improved their medical condition and some felt they had been misled and had not been told the remedy contained no active ingredients.

At the consultation event, the majority of the 29 participants were homeopathy service users and they described a positive experience of homeopathy and the ability to choose ‘holistic’ and non-pharmaceutical treatment. Participants also questioned what services they could use if they were unable to access homeopathy on the NHS and were concerned and angry about the service potentially being decommissioned. A small number of participants at this event agreed with the view that there is a lack of evidence regarding efficacy and felt it was an inappropriate use of NHS funds that would be better spent on other, more effective services.

Of the survey respondents, 73% (541 individuals) chose the option to stop funding all homeopathy services; when including only Liverpool residents in the analysis this decreased to 64%.  Twenty three per cent of survey respondents (170 individuals) wanted to continue to fund homeopathy services in Liverpool (either at current levels or to increase the budget); when only including Liverpool residents this proportion increased slightly to 30%. At the end of the consultation event the participants in the room (29 individuals) were asked to vote on their preferred funding option; twenty two participants (76%) wanted to continue the service and increase the maximum funding limit; three participants (14%) wanted to stay with the current situation and three participants (10%) wanted to stop funding the service.

There was some tension in what those in the consultation saw as acceptable and appropriate evidence about the effectiveness of homeopathy. Many participants in the survey and at the event reported their positive experience or anecdotal evidence as “proof” that homeopathy is effective.  There was a low understanding about how scientific research is conducted or evaluated. The NHS try to base funding decisions on rigorous, high-quality, unbiased, peer-reviewed research, however, the CCG is required to account of all evidence, including patient experience, when funding or discontinuing services.

Across the survey and the consultation event there was some confusion about what types of treatment come under the heading of “homeopathy”, with participants making reference to a range of herbal remedies and supplements. Iscador (a mistletoe extract) may be, in some cases, provided as a complementary treatment for patients with cancer, however, this is not a homeopathic remedy. There was also discussion (in the event and in the survey responses) about other herbal remedies and supplements.

END OF SUMMARY

So, why do I not think highly about exercises of this kind?

In general, surveys are tricky and often very dodgy research tools. Particularly in alternative medicine, they are as popular as they are useless. The potential problems arise from the way the methodology is often applied. For instance, sampling is crucial. If, like in the present case, no rigorous sampling techniques are applied, the results will inevitably be unreliable in reflecting the views of a population.

The findings of the survey above could easily be little more than a reflection of which camp had a better PR. Homeopaths usually are very good on such occasions at persuading others for homeopathy. In this case, the results show that, despite their best efforts, the overall vote was not positive for homeopathy. What we don’t know is whether this is a reflection on the ‘will of the people’. It could be that the public is much more against funding nonsense than this poll suggests.

I would also argue that letting people vote about the availability of medical interventions is nonsensical. The value of healthcare technologies is not determined by such ‘beauty contests’; the value depends on the scientific evidence, and that is not readily evaluated by non-experts. Imagine: next we might vote for or against bone-marrow transplants; who has the expertise to cast such a vote?

Oh yes, and the ‘small consultation’ – what was that supposed to be. Probably just an exercise in political correctness. Nobody in their right mind can have expected any meaningful insight coming from it.

Finally, I dispute that ‘patients’ experience’ is the same as ‘evidence’, as the summary above seems to claim. This is just nonsense. evidence is something entirely different from experience.

But politicians will disregard all this. They will say ‘the public has decided’ and will stop funding homeopathy on the NHS in Liverpool. More by coincidence than by design, this survey went into the right direction. Now one can only hope that the rest of the country will follow suit – on evidence, not on dodgy pseudo-evidence from surveys.

12 Responses to Is this the end of homeopathy in Liverpool?

  • THE GUARDIAN Thursday 25 September 2003
    The alternative professor

    “If you study medicine and pharmacology, you know [homeopathy] can’t work,” he says. The active substances in homeopathic medicines are so diluted that pharmacology says they cannot have an effect. “Then you start working in a homeopathic hospital and people get better. Is that a miracle? It certainly is very impressive for a young doctor.”…………. He treats his French wife with homeopathy, he says. “We were both brought up with it.” But he adds: “People mistakenly think I must be a promoter of complementary medicine – that I should have an allegiance to the camp. I don’t. My allegiance is firstly to the patient – I feel that very strongly as an ex-clinician – and secondly to science. If in the course of that I have to hurt the feelings of homeopaths I regret that, but I can’t help it.” ………………..His biggest frustration is over the lack of funding for the research he wants to do. It matters. A quarter of the population and close to 100% of cancer patients use complementary medicine, and yet 0.5% of charitable funds and 0.8% of NHS grants go to CAM studies. “That to me is pretty outrageous.” They have submitted more than 200 grant applications and roughly one in 20 is funded. “I’m a pretty tough guy and highly motivated, but when the young researchers have been turned down three or four times I find it hard to motivate anybody.” He is scathing about the grant review panels who reject applications because his researchers cannot use standardised doses of their therapies. “They are demonstrating that they are reviewing applications they should not be reviewing in the first place,” he says. ………”. Ernst insists he did not set out to use his academic position to become a famous debunker. His German father and grandfather were both doctors, and like many German doctors, his father prescribed homeopathic remedies. As a teenager in Munich he was treated for hepatitis with homeopathy by a family doctor, and recovered. After he completed his medical training his first job was in a homeopathic hospital. “The evidence 20 years ago wasn’t so negative,” he says. “I personally felt it might well go the other way. Of course, the assumptions on which homeopathy are based are utterly implausible, but the clinical evidence at one stage, when I started looking at this, seemed much more positive. I thought this [would be] an interesting field to investigate. Maybe there’s something fundamental to discover which means it becomes plausible, if you see what I mean?”

    What a difference 13 years makes!

    • “What a difference 13 years makes!”

      What a relief that 13 years can make a difference! The ability to change one’s mind in the face of evidence is a mark of intelligence. (I do realise that this statement will likely be meaningless to the touts of pseudomedicine)

    • Many patients and hence some of the providers of ridiculous treatments from witchcraft, voodoo and other forms of magic have been convinced their conditions were “cured” by such nonsense. That does not mean the alleged treatment worked any more than a palm reader can predict the future. Many patients get no relief from magic but the magicians do not talk about them. Snake oil works for some, but does it really?

  • The only issue for the CCG is whether the NHS should make provision for homeopathy – not whether homeopathy ‘works’ or is wanted/desired by a small group of patients.

    It remains open for those patients who wish to indulge themselves with homeopathy to do so on their own account. Just as they would if they fancied a new hair-do, a shopping trip, an nice sauvignon, a visit to the gardens of Highgrove House.

    If finance is a problem, then, as many patients have found, they might have to call on charity or the largesse of the manufacturers of homeopathic remedies. So be it.

    I suspect however that what many patients actually want is approbation for their belief system, and they seek ‘NHS approval’ to that end.
    The NHS (CCG) should not commission homeopathy unless or until NICE reports on its cost effectiveness. That is what the BMA policy is.
    But to date, NICE has declined to report. So be it.

    And of course this survey makes the mistake of conflating the type I effects of having a constructive therapeutic relationship with an empathic practitioner (nice), and type II effects of homeopathically prepared remedies on physiology, biochemistry or pathology of specific conditions (none whatsoever – so don’t fund them).

    Daft (as Edzard says) or what? A large thesaurus is needed!

  • Demaskers vs Debunkers

    A demasker is a neo St. Paul…knocked off by a blindling light…. driven by faith
    a debunker is a soldier caught in bunker of thought, trapped by their defense of something limited but noble/ and or nobel? I am a devacillator… I flip between one or the other. Better to be anything than a devacillator.

  • The mind that opens to a new idea never returns to it’s original size. – Albert Einstein

    Unlike the dear professor, science and research has moved on. Isn’t it time everyone watched the links below and opened their minds to the new discoveries concerning water?

    https://m.youtube.com/watch?v=59iuelCL0MQ&autoplay=1

    https://m.youtube.com/watch?v=i-T7tCMUDXU

    • “It pays to keep an open mind, but not so open your brains fall out.” — Carl Sagan.
      https://idoubtit.wordpress.com/2016/03/25/practical-skepticism-about-being-closed-minded/

    • No.
      Not unless they are published in reputable scientific journals,
      The clue is in the name: ‘scientific’.

    • @Karyse

      Before we start trying to explain HOW they work, we have to know IF they work. We have all seen several displays of wishful speculation of this kind.
      Most homeo-remedies are stored and sold as sugar pills. Please explain how the water, even if it could retain memory in some way, leaves this memory when evaporating from the sugar pills. Also explain how the pills were just as effective when produced by a machine that dropped the shaken water outside every fifth or sixth container of sugar pills??
      The accumulated evidence of two centuries only supports the inference that Homeopathic shaken water and sugar pills are ineffective and any perceived effect is that of wishful thinking (=placebo effect).
      A couple of Youtube videos about the different physicalcharacteristics of water or wild fantasies of water memory believers will not even start to refute that.

    • The mind that accepts all new ideas is doomed to help finance the charlatans and allow his bankroll to expand.

  • This was just announced (http://goodthinkingsociety.org/nhs-liverpool-ccg-ends-funding-for-homeopathy/):
    The Good Thinking Society welcomed today’s decision by NHS Liverpool CCG to decommission homeopathy services. The decision comes after months of public consultation which showed overwhelming support from Liverpool residents for an end to funding….

    • This news should be welcome by all homeopaths who are serious about moving their faith forward from the eighteenth century. They can now concentrate on what they appear to do well: offer care and consolation, but without the quack claims about remedies.

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