MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Herbal and homeopathic lobby groups have petitioned to stop NHS England from removing herbal and homeopathic medicines: NHS England is consulting on recommendations to remove herbal and homeopathic medicines from GP prescribing. The medicines cost very little and have no suitable alternatives for many patients. Therefore we call on NHS England to continue to allow doctors to prescribe homeopathy and herbal medicine. The petition received around 16 500 signatures.

Now the UK government has responded. I take the liberty of posting the full response below:

Information from NHS England (NHSE) shows that in 2015, the cost for all prescriptions dispensed in primary care, not including any dispensing costs or fees, was £9.27 billion, a 4.7% increase on the previous year. Due to the increasing cost, NHSE is leading a review of medicines which can be considered as being of low clinical value and develop new guidance for Clinical Commissioning Groups (CCGs).

On 21 July, NHSE launched a three month consultation on the draft guidance on low value prescription items which is based on the latest clinical evidence, including that from the National Institute of Health and Care Excellence (NICE). Careful consideration has been given to ensure that particular groups of people are not disproportionately affected, and that principles of best practice on clinical prescribing are adhered to.

The commissioning guidance, upon which NHSE is consulting, will be addressed to CCGs to support them to fulfil their duties around the appropriate use of prescribing resources. This will need to be taken into account by CCGs in adopting or amending their own local guidance to their clinicians in primary care.

The aim of this consultation is to provide individuals with information about the proposed national guidance and to seek people’s views about the proposals. NHSE welcomes the views of the public, patients, clinicians, commissioners and providers through this consultation process to help inform the final guidance. The consultation ends on 21 October. Links to the consultation can be found here:
https://www.england.nhs.uk/2017/07/medicine-consultation/ and
https://www.engage.england.nhs.uk/consultation/items-routinely-prescribed/

It is the responsibility of local NHS organisations to make decisions on the commissioning and funding of any healthcare treatments for NHS patients, such as homeopathy, taking account of issues to do with safety, clinical and cost-effectiveness and the availability of suitably qualified and regulated practitioners.

Complementary and alternative medicine (CAMs) treatments can, in principle, feature in a range of services offered by local NHS organisations. A treating clinician would take into account an individual’s circumstances and medical history in deciding what would be the most appropriate treatment for their condition. CCGs will have specific policies on the commissioning and funding of CAMs, and may have also developed local policies on priorities with regards to the funding of treatments. A GP would have to work within such policies in providing any treatments on the NHS.

The Department of Health supports an approach to evidence-based prescribing which does not support the commissioning of services which are not clinically and cost effective. We are not aware of any evidence that demonstrates the therapeutic effectiveness of homeopathic products. The National Institute for Health and Care Excellence (NICE) does not currently recommend that homeopathy should be used in the treatment of any health condition, whilst primary care prescribing data shows that there has been a significant decline in the prescribing of homeopathic products over the last 10 years. Furthermore, a good number of NHS organisations are reviewing their funding of homeopathic treatments and some have already stopped funding such treatment altogether.

Department of Health

END OF QUOTE

This hardly needs a comment. Perhaps just this:

I find phraseology such as “We are not aware of any evidence that demonstrates the therapeutic effectiveness of homeopathic products” regrettable. It enables homeopaths and their supporters to counter that the government or anyone else who use this argument are ill-informed. There are, of course, quite a few positive trials of homeopathy. To deny it is a mistake, in my view, and one that would be easily avoidable.

I would have formulated this sentence differently: “We are not aware that the totality of the reliable evidence demonstrates the therapeutic effectiveness of homeopathic products”.

That is a correct and relevant statement.

31 Responses to UK government response to petition ‘Stop NHS England from removing … homeopathic medicines’

  • No, the DoH is ‘not aware’ – even if others contend they have such awareness!
    Awareness is in the eye of the beholder.
    Others will have to press their case more effectively.
    Metaphysics and semantics should have no part in determining the practice of therapeutics.

    I am pleased to read that ‘homeopathic products’ are considered apart from the effects of empathetic consultations with homeopaths – which are no doubt often beneficial in assuaging emotional, spiritual and psychological issues.
    Have any ‘trials of homeopathy’ made this distinction?

  • I would formulate the sentence: there is no evidence of clinical efficacy of homeopathy established by RCT’s but there is evidence of efficacy of individualised homeopathic treatment (R. Mathie 2015). Dr Ernst stated that this MAY be so.

    • no, there is no such evidence either – only if you omit 2 of the most rigorous trials!
      http://edzardernst.com/2014/12/homeopaty-proof-of-concept-or-proof-of-misconduct/

      • That blog was one of your best, fair enough.

        In the extract to Mathie’s study, it states: ‘Thirty-two eligible RCTs studied 24 different medical conditions in total.’

        In order for a clear investigation into individualised homeopathy to begin: the words ‘medical conditions’ need to be replaced with ‘individual health condition’. This is because no two individuals with the same ‘medical condition’ are alike in other respects: measuring homeopathy against ‘medical conditions’ is not individualised homeopathy.

        The measure of individualised homeopathy is the measure of overall improvement in symptoms and condition of the individual patient. And, importantly, recognising that many ‘medical conditions’ are not improvable or curable with homeopathy.

        My conclusion: The last decades of homeopathy research have been a total waste of time and money.

        Thank you for your input in helping to clear this mess up Dr Ernst.

        • ” The last decades of homeopathy research have been a total waste of time and money. ”
          I agree – but the preceding decades have been worse.

          • I am not sure what the future of homeopathy research is going to be like because who will pay for research on individualised homeopathy if the result can’t be patented, trade-marked and packaged to sell in the health/medical market.

          • SAME PROBLEM IN MANY FIELDS OF HEALTHCARE, e .g. surgery, physiotherapy etc. etc.

          • Greg said:

            I am not sure what the future of homeopathy research is going to be like because who will pay for research on individualised homeopathy if the result can’t be patented, trade-marked and packaged to sell in the health/medical market.

            That’s curious. A quick search of Google Patents for homeopathy OR homeopathic returns 14,226 results; many brand names, slogans and logos for homeopathic products are trade marks and many homeopathic products are clearly packaged to sell in the ‘medical/health market’. But who do you think should pay for further research if that’s deemed necessary?

    • Can this efficacy of individualized homeopathic treatment be consistently be shown to be anything other than placebo effects? The burden of evidence is on the person presenting the claim. Coming up with untestable situations is not acceptable in other parts of medicine. There is no reason to make a special case for homeopathy other than to try to show evidence when you have none.

      • I’ve made this comment in the past, but it may be worth repeating in this thread.

        James Randi, who offered a million dollar prize to anyone making a paranormal claim that could be proved under controlled conditions, came up with the following trial protocol to test homeopathy. All patients, regardless of their condition, receive the usual individualized loving care and attention from a homeopathic consultation and they are prescribed whatever the homeopath deems necessary. Prescription changes on return visits are allowed, as usual.

        Behind the scenes, each patient is randomized to receive the genuine, potentized ‘medicine(s)’ or an identical placebo (not difficult with homeopathic medicines). Both the homeopath(s) and their patients are blinded to the true nature of the product they receive. (Detailed protocols for this sort of thing are the bread and butter of good, prospective, randomized clinical trials.

        After a time (negotiable), the patient makes a return visit to the homeopath and, on the basis of a consultation, the homeopath judges whether the patient received verum or placebo treatment. If the homeopath(s) call things correctly more often than statistically predicted by chance, then there’s something worthy of further investigation in homeopathic medical products.

        Edzard can point us to a small number of trials that have been done in a broadly similar manner, but with the important difference that they’re restricted to specific medical conditions and an objective assessment is used to judge clinical response. Under the Randi protocol, the person who makes the extraordinary claim that ultra-dilute, succussed preparations have a detectable medical effect are put in the position where they need to show they can truly detect the effect of those preparations.

        Of course, there would need to be a far more detailed account of the protocol, and it would need to have the full agreement of participating homeopaths. But I bet you’d never get a homeopath to agree to such a protocol (and/or enrol sufficient patients to make the exercise robust science).

      • Bang on!
        100%
        Self-evident to most of us.

        For everyone’s sake, let us move on.

        The HP manufacturers can diversify and expand their existing product lines in the beauty business, and even (if they are honest) – ‘wellness’. But stop false and fraudulent sales pitches.
        The lay homeopaths can learn better counseling skills.
        Medically qualified homeopaths can do what they should have been doing all along – care.
        Patients should set aside faith and wishful thinking and consult with practitioners of integrity – not sycophants (some of whom would like to receive or receive more national honours).
        Patients in positions of influence over others must look to their consciences.
        Holders of Royal Warrants for the provision of homeopathic remedies should hand them back.

        Homeopathy RIP (along with numerous other ideas, concepts and treatments used for healthcare down the millenia).

  • Greg

    Individualized homeopathy is the cornerstone of the modality. It is in the interest of all homeopaths to promote and fund research into it because if positive results are found, their very existence is validated. Similarly, Boiron and other manufacturers of the preparations have an iron in the fire.

  • The Department of Health (DH) have the legal power to blacklist products and prevent their prescription by NHS England GPs but despite pressure from the Good Thinking Society requesting a judicial review, they’ve shown no inclination to blacklist homeopathic medicines.

    NHS England and CCGs do not have the power to prevent GPs prescribing.

    I suspect that part of the DH’s “hands off” approach here is the desire for NHS England to take the blame for what might be seen as an unpopular decision. Politicians seem to have a distorted view of how many votes there might be in homeopathy.

    I’ve written a bit more about the consultation on my blog.

  • Professor Odds, Mr Randi’s offer was taken up by Professor Vithoulkas and then something went amiss between the two of them. Alan and I discussed this affair between Randi and Vithoulkas (no guessing who took whose side) but I don’t have the facts so no point making a case out of it. The test was not going to be a test of individualised homeopathy: it was going to be a proving of Alumina: homeopaths would have to know which of the subjects had received the Alumina and which had received placebo. 70% accuracy of prediction was considered the marker.

    Your suggestion is good though. In a study of individualised homeopathy, the lessening of the intensity of symptoms, or their frequency, or change of symptoms, or cessation of symptoms completely, in conjunction with overall measures of health and patient’s wellbeing indicators CAN BE observed by homeopaths (depending on the skill of the homeopath). The study would also enable Dr Rawlins mention of TLC effect to be included in the study.

    The main problem that I have noticed in the discussions is the issue of the physics of homeopathic dilutions that theoretically mean that there is no molecule of the original substance in the solute potency C12 and beyond. In theory, this means that there is zero prior probability of obtaining positive outcomes for those receiving the remedy as opposed to placebo. This is really the crux of the problem with homeopathy: its lack of scientific credibility due to zero plausibility according to laws of physics, chemistry and every science associated with medicine. I have a theory regarding this matter but I am keeping this to myself (if I mention it, who knows: some university may say ‘ah yes we are working on that, and have been doing for the past God knows how long; even the Bank of England could be working on it: you never know. Or, my theory could be rubbish too).

    Lenny mentioned Boiron and other manufacturers having incentive to carry out trials: no, homeopathy is open source: a licenced pharmaceutical company can register remedies under one of the UK homeopathic registration scheme and manufacture and sell. The registration is only a manufacturing licence, it has nothing at all to do with the medicinal value of the product. So if Boiron proves the x remedy works then Weleda can benefit from this too because they also make most of the remedies. If it was PROVEN that homeopathy really works then governments would no doubt step in to create control licences for a monopoly of manufacturers to bring the cash in, but, at this moment, it is not like that.

    • This is really the crux of the problem with homeopathy: its lack of scientific credibility due to zero plausibility according to laws of physics, chemistry and every science associated with medicine. I have a theory regarding this matter but I am keeping this to myself (if I mention it, who knows: some university may say ‘ah yes we are working on that, and have been doing for the past God knows how long; even the Bank of England could be working on it: you never know. Or, my theory could be rubbish too)

      You’re right, it could be rubbish dear Greg. Actually it very likely is. But you might be right, that someone at some university is working on it. Like RT Mathie PhD, he likes rubbish theories.
      But we promise not to laugh if you tell us yours (at least not for long).

      • This is quite right. Another perfect example of cognitive dissonance. One knows why they shouldn’t believe in something, but choose the mental discomfort of retaining invalid said belief…

        The “issue of the physics of homeopathic dilutions is not theoretical, it is practical. No molecule remains, unless the dilution is not carried out correctly, of course. And, the thing is, governments etc. would have stepped in and Big Money would start to be made in one way or another, which is why everybody tried their best to prove it works. After piles of negative or unreliable evidence, they stepped back, because, of course, it doesn’t work. Now, it rests safely in the arms of Big Cashebo…and a fair amount of people who are stepping on he thin line between reality and wishful thinking.

  • Edzard:

    Iqbal is a believer in homeopathy.

    Bjorn Geir believes that he is a surgeon and doctor, and expert commenter on homeopathy.

    Who is more deluded?

    By the way, thank you for the last 5 years of work in debunking clinical homeopathy on your website edzardernst.com: your contribution to homeopathy is immense.

    It is now time to say good-bye Edzard Ernst.

  • Well, I think for once you are right dear Greg. I do believe I am a surgeon and doctor, a real one. At least I’ve spent the last almost four decades working as one 😀
    And what is more, I have the credentials to prove I am right too. Where are yours?
    Last time I visited the blog I even gave you the link to my information. Do you need help following it? Perhaps the village library?

    And regarding the expertise on homeopathy, I know more than you do, and I can prove it 😉

  • I believe if ‘ol Donald-the-Trump were to turn his senseless, idiotic and narcissistic efforts away from running the United States into the ground and towards homeopathy he would sound suspiciously like ‘Greg’….

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