Have you ever wondered whether doctors who practice homeopathy are different from those who don’t.
Silly question, of course they are! But how do they differ?
Having practised homeopathy myself during my very early days as a physician, I have often thought about this issue. My personal (and not very flattering) impressions were noted in my memoir where I describe my experience working in a German homeopathic hospital:
… some of my colleagues used homeopathy and other alternative approaches because they could not quite cope with the often exceedingly high demands of conventional medicine. It is almost understandable that, if a physician was having trouble comprehending the multifactorial causes and mechanisms of disease and illness, or for one reason or another could not master the equally complex process of reaching a diagnosis or finding an effective therapy, it might be tempting instead to employ notions such as dowsing, homeopathy or acupuncture, whose theoretical basis, unsullied by the inconvenient absolutes of science, was immeasurably more easy to grasp.
Some of my colleagues in the homeopathic hospital were clearly not cut out to be “real” doctors. Even a very junior doctor like me could not help noticing this somewhat embarrassing fact…
But this is anecdote and not evidence!
So, where is the evidence?
It was published last week and made headlines in many UK daily papers.
Our study was aimed at finding out whether English GP practices that prescribe any homeopathic preparations might differ in their prescribing of other drugs. We identified practices that made any homeopathy prescriptions over six months of data. We measured associations with four prescribing and two practice quality indicators using multivariable logistic regression.
Only 8.5% of practices (644) prescribed homeopathy between December 2016 and May 2017. Practices in the worst-scoring quartile for a composite measure of prescribing quality were 2.1 times more likely to prescribe homeopathy than those in the best category. Aggregate savings from the subset of these measures where a cost saving could be calculated were also strongly associated. Of practices spending the most on medicines identified as ‘low value’ by NHS England, 12.8% prescribed homeopathy, compared to 3.9% for lowest spenders. Of practices in the worst category for aggregated price-per-unit cost savings, 12.7% prescribed homeopathy, compared to 3.5% in the best category. Practice quality outcomes framework scores and patient recommendation rates were not associated with prescribing homeopathy.
We concluded that even infrequent homeopathy prescribing is strongly associated with poor performance on a range of prescribing quality measures, but not with overall patient recommendation or quality outcomes framework score. The association is unlikely to be a direct causal relationship, but may reflect underlying practice features, such as the extent of respect for evidence-based practice, or poorer stewardship of the prescribing budget.
Since our study was reported in almost all of the UK newspapers, it comes as no surprise that, in the interest of ‘journalistic balance’, homeopaths were invited to give their ‘expert’ opinions on our work.
Margaret Wyllie, head of the British Homeopathic Association, was quoted commenting: “This is another example of how real patient experience and health outcomes are so often discounted, when in actuality they should be the primary driver for research to improve our NHS services. This study provides no useful evidence about homeopathy, or about prescribing, and gives absolutely no data that can improve the health of people in the UK.”
The Faculty of Homeopathy was equally unhappy about our study and stated: “The study did not include any measures of patient outcomes, so it doesn’t tell us how the use of homeopathy in English general practice correlates with patients doing well or badly, nor with how many drugs they use.”
Cristal Summer from the Society of Homeopathy said that our research was just a rubbish bit of a study.
Peter Fisher, the Queen’s homeopath and the president of the Faculty of Homeopathy, stated: “We don’t know if these measures correlate with what matters to patients – whether they get better and have side-effects.”
A study aimed at determining whether GP practices that prescribe homeopathic preparations differ in their prescribing habits from those that do not prescribe homeopathics can hardly address these questions, Peter. A test of washing machines can hardly tell us much about the punctuality of trains. And an investigation into the risks of bungee jumping will not inform us about the benefits of regular exercise. Call me biased, but to me these comments indicate mainly one thing: HOMEOPATHS SEEM TO HAVE GREAT DIFFICULTIES UNDERSTANDING SCIENTIFIC PAPERS.
I much prefer the witty remarks of Catherine Bennett in yesterday’s Observer: Homeopath-GPs, naturally, have mustered in response and challenge Goldacre’s findings, with a concern for methodology that could easily give the impression that there is some evidential basis for their parallel system, beyond the fact that the Prince of Wales likes it. In fairness to Charles, his upbringing is to blame. But what is the doctors’ excuse?
16 Responses to Homeopathy: our (‘just a bit of rubbish’) study that made the UK headlines
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For “patient outcomes” I read “…perceptions”.
Marketing, advertising and the fact that Fred buys this gloop are no reason to think it’s anything but gloop. Yet if Fred’s a doctor, friend or loved one, we sidestep any rigour that our opinion-forming process may have.
I suspect that many will be familar and now rather bored of my bringing up every five minutes but these NHS England vary not only from other GPs but most of their private practice homeopathy prescribing bretheren in a key way. They are not homeopaths, they are Anthroposophic doctors. They are part of the Steiner cult. Anthroposophic doctors use herbal concoctions – like the infamous Iscador – as well as homeopathic medicines (but they might have be to sourced from Weleda or other mostly German anthroposophic medicines manufactuerers).
Anthroposophic doctors do prescribe conventional medicines. It would not be surprising if Anthroposophic doctors have certain preferences for medicines they ascribe special properties to. This might apply to the used of branded over generic medicines. I’ve a tiny amount of information that links some very odd formulations of medicines to Steiner GP practices.
I used EBM DataLabs Open Prescribing tool to obtain data for this analysis http://ukhomeopathyregulation.blogspot.co.uk/2017/12/nhs-homeopathy-3-analysis-gp.html
If the St. Luke’s Medical Centre had not closed, current NHS England spending on homeopathic medicines would be much higher.
Quality of GP prescribing is a bit of a nebluous concept. Given the nature of the source data, it’s impossible determine whether medicines have been appropriately prescribed – although for some medicines, any prescribing is inappropriate – which is why NHS England did the Items which should not be routinely prescribed in primary care: A Consultation on guidance for CCGs. The kind of analysis Fisher et al wants is expensive and time consuming. It would be a tremendous waste of resources.
Obviously those want to “Save NHS Homeopathy and Herbal Medicine!!!!” will be upset. The paper certainly does not help the British Homeopathic Association’s application for Judicial Review. http://ukhomeopathyregulation.blogspot.co.uk/2018/04/nhs-homeopathy-5-update-of-british.html
GIGO!
This “study” used an untested and not validated questionaire…and it is remarkable that ANY serious medical journal would publish such rubbish, but the bottomline is that the “results” fits the Big Pharma and Big Medicine narrative.
The Britich Homeopathic Association said it short and sweet:
https://www.britishhomeopathic.org/bha-blog/homeopathy-not-related-poor-gp-performance/
It is so cute that Ernst and others stand behind something as firm as this “jello” of firm ground!
I am soooo glad you agree with all the other homeopaths unable to read a scientific paper.
if not, we would have had to suspect that you are actually on a learning curve.
All those peer-reviewers and editors all obviously in the pay of Big Pharma. Has to be the answer, doesn’t it?
is it only I who is still waiting for the cheque?
I’m still waiting for mine.
better to stand on jelly than on shaken water!
Dana – the study uses NHS England prescribing data. This data is captured electronically so that NHS England can re-imburse community pharmacies for the cost of medicines dispensed against NHS prescriptions. Community pharmacies commercial enterprises – they have contracts with NHS to do things like deal with prescriptions – but they do other things like retail sale of OTC medicines (including homeopathic and herbal), cosmetics, toiletries, disability aids. Like US pharmacies I’ve been in. They are not part of the NHS. Degree to which they depend on NHS contracts varies. Chains like Boots not so much but those serving deprived areas very much so. Some are closing as a result of changes to contract payments.
Community pharmacies depend on the accuracy of the data. NHS England has a Fraud department part of whose remit involves prescription fraud. The data is not perfect by any means. Oh, https://openprescribing.net/ lets you look at.
Where does this “questionaire” business come from? Did you make that up? Did you get that from someone else?
As for the BHA statement, whilst they have a long history of gross misrepresentations, they don’t mention a questionaire. BHA criticise the study for making claims it actually doesn’t. BHA don’t understand the nature of the data involved or the analysis performed.
Oh you are amusing, Dana!
I don’t think I’ve ever seen a study Ad Hom’d.
Rather than dismissing it because it’s untested you could be way more constructive… sorry, you could be actually constructive if you were to point out issues with the testing method. As it stands you just sound whiny.
I do like the “stand behind something as firm as this “jello” of firm ground” though. Once you get past the appalling grammar and realise that the “firm ground” homeopathy stands on is literally just water.
[laff]
It’s homeopathic grammar, highly sophisticated. We are simply too uneducated to see that.
[/laff]
It’s not appalling grammar; it’s just that linguists haven’t yet developed the tools and understanding needed to explain it…
[clap clap clap]
Well played sir. 🙂
LOL 🙂