MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

An article in the medical magazine ‘GP’ caught my eye. In it, a GP from Southampton argues that it is counter-productive for the NHS to ban ineffective treatments. Here are a few excerpts (my comments are inserted in brackets and are in bold print):

START OF QUOTES

NHS England’s recent decision requiring GPs stop prescribing a list of 18 medicines will reinforce the fears of many doctors that healthcare rationing is being introduced by the back door (all finite NHS resources need to be and always have been rationed). I would also argue that it is an illogical and ill-informed decision that will not achieve the professed aim of saving NHS resources (perhaps the decision is not purely based on the need to save money but also on a matter of principle and an attempt to make the NHS evidence-based?).

The decision to impose a blanket ban on these items will disproportionately affect those patients who currently receive free prescriptions: the young, the poor and the elderly (where is the evidence for this statement?). The conditions these patients are suffering from will persist (treating them with ineffective medications would also make them persist).

If in future these vulnerable patients want to continue with their medicines, they will be forced to pay for them. While wealthier patients will have the option to pay for their medications, those unable to do so will return to their GP for an alternative medication or procedure that has not been prohibited by NHS England’s recommendations. GPs will then find themselves prescribing other more costly medications. How this is helping NHS England to reduce prescribing costs is difficult to see (really? I don’t find it difficult to see that spending money on effective treatments is a better investment than wasting it on ineffective stuff)…

… ‘evidence-informed practice’… not only includes scientific research, but also evidence from clinical practice acquired over many years and endorsed by numerous clinicians. Yet this type of evidence, from the front line of medicine, is being dismissed as ‘unscientific’ or ‘anecdotal’ (no, it has never been considered to be evidence; remember: the plural of anecdote is anecdotes, not evidence)…

We all want the NHS to operate cost effectively… (as long as the NHS continues to pay for homeopathy?). Of course, treatments that have no good evidence of benefit to patients should be questioned (as long as the NHS continues to pay for homeopathy?)…

NHS England needs to conduct a review of how it evaluates treatments and take far more notice of the experiences of doctors and patients. Then perhaps we will see a more financially efficient health service, healthier patients and an end to the injustice of healthcare rationing (the author forgot to tell her readers that she is a homeopath – in fact, she did not even once use the word ‘homeopathy’ in her diatribe. Because of her extreme views, she has featured on this blog before. [“homeopathy can be helpful for pretty much any condition”] Dr Day also forgot to declare conflicts of interest in her most recent vituperation [easy mistake to make; I know I am being petty).

 

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If I were a fan of homeopathy and a believer in the magical healing power of shaken water, I would be very worried. While homeopaths put forward such embarrassingly daft arguments, the future of homeopathy looks bleak indeed.

 

 

16 Responses to Banning ineffective medicines on the NHS is “illogical and ill-informed”

  • 100% endorsement of this post.
    I hope this post is sent to ‘GP’, and that they publish it.
    Homeopathic preparations are not ‘medicines’.
    If this doctor leads her patients to believe they are, she is practising unethically.

  • That is really interesting. The problem of anecdotal medicine is highlighted by the use of Belladonna as a preventative and treatment of scarlet fever in the early 19th century. If one reads contemporary papers, they hailed this treatment as breakthrough against this disease. Then came J.W.Begbie and looked at the mortality:”Vaccination in its effects made itself at once recognised, and the contrast between the ravages of smallpox at the commencement of this century, and the almost entire immunity from that disease in an epidemic form which now prevails, are facts so plainly recognisable, and so appreciable, as in the instance of that disease entirely to remove the difficulty referred to. It is altogether otherwise with scarlatina; notwithstanding the introduction of belladonna, and its extensive employment both in this country and abroad, as a prophylactic against scarlet fever, we are not aware that the mortality in either has been
    reduced ;” (Begbie JW (1855). On the use of belladonna in scarlatina. British and Foreign Medico-Chirurgical Review or Quarterly Journal of Practical Medicine and Surgery XV:77-101.)

  • Another demonstration of the fractured logic and muddled thought-processes of homeopaths. They are fundamentally incapable of reason; is this what leads them along the path of believing in the mysterious powers of magic shaken water?

  • “NHS England needs to … take far more notice of the experiences of doctors and patients.” Yet another example of the inability of Homo sapiens to recognize how easily we’re deluded by our own subjective experiences.

  • See my comment on this article (scroll down). It’s hardly ethical to fail to declare an interest.

  • Ah, this is very interesting.

    Dr Day would appear to be a member of the Faculty of Homeopathy – it says on the Burgess Road Surgery website http://www.burgessroadsurgery.co.uk/pages/Main/The%20Doctors.htm

    However, the OpenPrescribing.net tool reveals no spend on prescriptions for homeopathic medicines for that practice over the past 5 years. Which is unsurprising given that the Southampton CCG formulary does not include homeopathic medicines.

  • Isn’t this an example of someone misrepreaenting their efforts to protect an income stream?
    Surprising that a reputable professional journal doesn’t ensure such conflicts of interest are exposed prominently alongside the letter – with added emphasis of withheld by the author.

    So often, my view of someone’s argument or claim is undermined by discover of a flaw in their declarations. This is sad, because any genuine assertion made is dwarfed by unreliability in all other eegards

  • Dr Rawlins really should educate himself with the legal classification of a homeopathic medicine.
    https://www.gov.uk/guidance/register-a-homeopathic-medicine-or-remedy

    Note the MHRA on their website use the spelling ‘homeopathy’whilst in the regulations it is spelt ‘homoeopathy’. So Alan is correct to refer to ‘homoeopathic medicinal product’ with regard to the HMR 2012.
    Does this mean that ‘UK Homeopathy Regulation’ is using the wrong username? Should ‘UK Homeopathy Regulation’ change his/her username to ‘UK Homoeopathy Regulation’?

    • @JK 🙂

      I’m sure you know the two spellings mean the same thing: they’re as equivalent as ‘colour’ and color’ (though not UK vs US!). Click here for a good account.

      Your spelling as ‘homoeopathy’ is not correct. To type the ligature œ on this blog hold down the Alt key and type 0156 on the numeric keypad (with Num Lock ON). Capital Œ is Alt+0140. (This applies to a Windows PC: I don’t know how to do this on a phone!)

  • Not criticising Ernst’s statements in the post above. But I do not understand what you are talking about here. The one article not behind a wall says:
    “The consultation will include proposals to stop routine prescribing of OTC medicines for 34 conditions that are either self-limiting or conditions where patients could self care. This covers conditions including oral thrush, simple constipation, mild acne, mild hayfever and infant colic.”
    That your favenemy homeopathy falls under that might incite your vigour, but that’s not what it’s about? In the article I quote it’s all about cost, and also how effective drugs, like paracetamol, should be paid without solidarity when needed. No scientific medicine there, only financial politics of liberalised, privatised, financially individualised health care.

    This just looks like a cheap cop out for the NHS to transfer the financial burden of treatment (whether effective or not) on the poorer parts of society. Just because something is available OTC says nothing about effectiveness or need. You might want to defocus from homeopathy. Banning prescription on that is all swell. And oh so uninteresting. But where is that list of 34 conditions and 18 medications? Then we might laud or criticise aspects of effectiveness.

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