NHS Wirral and The North West Friends Of Homeopathy: A Typical Wednesday Evening Out


I’ve had a rather interesting evening. Last week, MSS member and local councillor Darren Dodds alerted me to the fact that Wirral NHS were holding an open meeting to discuss whether to continue funding homeopathy in the region, with the recommendation being very much ‘No, we absolutely shouldn’t’. Needless to say, I agree with this recommendation, and wanted to go along to let them know that I – and by extension the hundred or more local MSS members – applaud their step in the right direction. Interested parties should read the report they came up with, it’s really pretty good. Some highlights:

The paper concludes that the lack of evidence on efficacy and cost-effectiveness of homeopathic therapies means that it should not be a high priority for the PCT at this time. It is recommended that NHS Wirral does not commission homeopathictherapies.

The key risk is that NHS Wirral fails to maintain its reputation as an evidence-based commissioning PCT.

Excellent stuff. Still, it seems we weren’t the only ones made aware of the open meeting – also invited were patients currently or formerly using homeopathy, and the ‘North West Friends of Homeopathy‘. This latter group are most interesting, and I’ll come back to them a little later in more detail, but first it’s worth pointing out that I appeared on local radio with a member of the group on Monday morning, in an exchange that might amuse, and will certainly give a far better impression of who John Cook is than I could ever do justice with words. UK-based readers can listen here, it starts around the 2hour 13minute mark and lasts about 10 minutes. I’ll wait.

For those not able, willing or interested in listening, what we have from John is a charming ability to hog a conversation, and the maniacal insistence that the date of the meeting was aired. Clearly, John wanted his supporters to arrive mob-handed. Fair enough, he probably feels he has a strong case. As it was, when I arrived with a couple of other MSS members there were maybe 40 or so people present, a number which I presume to be in excess of the general norm for these meetings.

John, having lobbied for inclusion, was amongst the speakers, joined by Dr. Hugh Neilsen BA MA BM BCh MRCP FFHom (it’s worth pointing out that his name is actually Hugh Nielsen, and the NWFoH’s own website, while painstaking in it’s detail of Hugh’s many qualifications, mispells the name of their own president), and the panel was completed by two local GPs who were involved in making the recommendation, and who spent the evening ranging between bemused, compassionate and at times startled. Startled, not least, by the quite spectacular opening by John, the homeopath’s friend (which I imagine is rather like a Fisherman’s Friend, but lacking in clout), in which he directed a quite flattering string of insults at me directly, and at the Merseyside Skeptics Society. A typo on our website (proclaiming the meeting to be on the 6th not the 9th) drew from John the hilarious gag:

Perhaps you’re the Merseyside Dyslexics Society, although you’ve somehow managed to make it here on the right night so perhaps you can get by. (*from memory, not verbatim*)

Clearly the friends of homeopathy are no friends of dyslexics, I suppose. Either that or he had a range of tinctures in his impressively boxy briefcase, and was merely touting for business. Who knows. Still, it was a harmless enough jape (unless you are actually dyslexic, in which case I’m sure it was infuriatingly insulting), but I assume not the standard practice for such meetings as the Chair looked quite surprised. John’s epic 10-minute rant (he moved to stand behind the Chair so everybody could see him in full), whilst including a few more rib-ticklers at my expense (I was merely an audience member at this point, bear in mind), also included a number of utterly wonderful assertions, which he’d taken the time to print for us (with such adherence to spelling and grammar as to paint his dyslexic wisecrack in immensely ironic light) and which I can reproduce here verbatim from the copy I took away with me.

North West Friends – Small Registered Charity supporting Patients.

This is interesting to me, given that the Charities Comission has NWFoH listed as being for:

THE RELIEF OF SICKNESS BY HOMOEOPATHIC MEDICINE. THE EDUCATION OF THE GENERAL PUBLIC IN THE BRANCH OF MEDICINE KNOWN AS HOMOEOPATHIC MEDICINE AND TO ASSIST IN RESEARCH OF HOMOEOPATHIC MEDICINE, THE RESULTS OF SUCH RESEARCH BEING DISSEMINATED TO THE PUBLIC AT LARGE.

Am I splitting hairs there? I think not – the NWFoH are very much designed to support homeopathy as a system, to further its usage and to promote homeopathy wherever possible. Clearly this is not the same thing as supporting patients – it’s supporting homeopathy. They’re not the North West Friends of Patients, after all, and were the interests of homeopathy to be in conflict with those of patients (like, say, when over 200 trials show homeopathy to be ineffective for patient use and a local PCT recommend, for increased patient care, the cessation of homeopathy funding), it’s easy to see where John and the rest of the NWFoH’s chips would fall.

10% each year of the UK population use homeopathy

This struck me as grossly exaggerated, but as one of John’s ill-judged and smug barbs pointed out ‘this includes the many skeptics who were seen debauchedly gulping entire bottles of homeopathy outside of Boots’. On this point, I agreed with him (we did), although the 10% still looks over-inflated to me. Small point, though, there’s better to come.

John also went on to claim that the Government rejected the Science and Technology Comittee’s recommendation to cease funding for homeopathy (implying that for a PCT to do so, citing the Evidence Check, would be out of line). This, as I pointed out to John when given the chance to retort from my seat in the audience, was highly disingenuous and misleading – the Government actually said that any decision should be made not by them but by local PCTs after local consulation. And we were sat in that local consultation at that very minute. Bewildering.

In perhaps John’s coup de grace, he stated defiantly:

Despite the Department of Health’s rejection of the conclusion of the Evidence Check Report, Wirral PEC’s recommendation says ‘there is no evidence that homeopathy works beyond the placebo effect; which is another way of saying there is no evidence of efficacy (RTCs) – which is wrong, because there is.

Brilliant. Let’s take this point by point:

  • The Department of Health did not reject the conclusion of the Evidence Check Report, as covered above. Furthermore they agreed that the evidence was in fact lacking, they merely disagreed that there should be top-down cessation of funding.
  • I’ve no idea what an RTC is – a typo is a petty thing to pick up on, admittedly, but given John’s smug gloating over the supposed date error on our own website, I couldn’t resist. An RCT is a Random Controlled Trial – that John can’t get those words in the right order speaks volumes about the NWFoH’s understanding of evidence standards.
  • Finally, the best bit – ‘which is wrong, because there is’. Now, you doubtlessly expect the next paragraph to explain this bold assertion. Who am I kidding, no you don’t – you rightly suspect John threw it out there nakedly and expected us to buy it without anything at all to actually back it up, as if merely saying something is enough to make it sound so. Which is right, because he did.

That summed up the thrust of John’s ‘arguments’, aside from another couple of swipes at the very fact that skeptics exist and personal digs at me and the MSS in general, and it was at this point that the Chair, out of keeping with the planned structure of the evening but slightly perplexed by John’s use of his time in attacking a hitherto-silent audience member, allowed me a moment to rebut. Fortunately, I had my rebuttal somewhat planned, and it ran along the lines of these very simple, demonstrable facts:

  1. The Merseyside Skeptics Society is a volunteer organisation with no commercial vested interests clouding our objectivity.
  2. The North West Friends of Homeopathy are headed up by John Cook (who appears to have been at one point the Chairman of the British Homeopathic Association, although I’m lacking citation for that and may be mistaken by an identically-named homeopath) and President Hugh Nielsen, who is also Clinical Lead of Old Swan Homeopathic Clinic, Liverpool
  3. The North West Friends of Homeopathy state on their website that their homeopathy supplier is Weleda Ltd
  4. Weleda Ltd is a large multi-national corporation operating in 53 countries with an annual turnover of around $300m
  5. Weleda Ltd produce homeopathic products, and also the non-homeopathic Iscador (made from mistletoe, and often lumped in with homeopathy for reasons too complicated to go into here).
  6. Welada Ltd currently supply Iscador and homeopathic products to… Old Swan Homeopathic Clinic, where Hugh Nielsen – President of NWFoH is Clinical Lead.

These facts, which I’ve seen nothing to suggest are incorrect, do not of course show any solid financial incentive behind the supposedly-grassroots, ‘supporting the patients’ activities of the NWFoH, however they do make it hard not to wonder that objectivity may be compromised – homeopaths spontaneously campaigning to have preserved a contract that their supplier benefits from financially.

The rest of the evening was genuinely fascinating – clearly many of the people who had turned up (those not part of John’s own group, of which there seemed to be several)  had done so out of genuine belief that homeopathy was an effective treatment. Each shared their own tale – terminal cancers held back by homeopathic products, ADHD abated without the need for drugs, breast cancer completely cured by homeopathy. Interestingly, there was an overwhelming preponderance of cancer patients present, and I think this reflects the intentional muddying of the lines between homeopathy, Iscador, and homeopathic Iscador. As the Chair was quick to point out, any case relating to Iscador was fundamentally not one the session was set up to consult on, and still the entirely-sincere and doubtlessly-genuine cancer cases came in. This made me wonder, especially as Monday’s radio phone in seemed curiously skewed towards Iscador stories too, whether there wasn’t an intentional drive to get such patients to come along, with their deeply-emotive – though irrelevant to the subject at hand – cases. If I were an astroturf organisation shilling for an Iscador manufacturer, I’d imagine that’s the kind of situation I’d try and promote.

Still, I felt nothing but empathy for the majority of the cases in the room (by which I mean the ones who weren’t nakedly hostile to the very notion of a skeptic, which formed a minority I imagine). Most of the people there were genuine in their concerns, and really wanted clarity and answers – they were just missing the objectivity that comes with not being in the centre of the storm. It is incredibly hard to accept such counter-intuitive notions as regression to the mean, confirmation bias and spontaneous recovery when you’re the one involved – as human beings we’re built to fit our lives into some kind of understandable narrative and see pattern and structure where there is, sometimes, chaos and randomness, and we’re all susceptible to this. It really did reinforce to me the need to be compassionate and considerate when dealing with people who have been convinced by a particular pseudoscience – even the most vociferous of proponents can themselves be victims, and frequently this is the case.

Amongst the stories told, the recurring theme which became apparent to me was of people who, when desperate, had been convinced to try homeopathy – perhaps by reputation, perhaps by recommendation from a well-meaning or otherwise practitioner. Also recurring, too, were stories of dismissal of the treatments by medical practitioners, and it did make me wonder just how many people would put their faith in homeopathy if explained clearly and gently why those little pills have no clinical effect, and how the placebo effect really works, rather than simply dismissed out of hand (admittedly by doubtlessly busy doctors who have real and pressing issues to deal with – a situation which will only increase now GPs are left holding the purse strings). I wonder if a moment’s pause and patience at the point of first experience might keep many more patients from falling for the weasel-wording of Dr Nielsen (who visibly squirmed when fellow skeptic Tom Williamson pressed him on Nielsen’s own explanation of how homeopathic substances get more effective once the initial substance has been diluted out of them) and the sneering and bullish hyperbole of John Cook.

Ultimately, however, I don’t really believe the discussions this evening will have affected the decision to be made over homeopathic funding, partly because I don’t think it really was – or was even pretending to be – a discussion. ‘Have your say’ invited the website – and plenty of people did. However, there is a significant difference between having your say, and having a vote, and I strongly think in this instance the evidence will outweigh the few passionate-but-sincerely-misguided opinions of the homeopathy users, and the smug point-scoring of the North West Friends of Homeopathy (Manufacturers). I, for one, eagerly await the outcome on March 22nd.

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  1. #1 by Guy Chapman on March 10, 2011 - 10:07

    John is clearly missing his vocation: he should be a politician. Say what you came to say and don’t allow anybody to deflect you from the bullet points you brought, political interviewing 101.

  2. #2 by Jonathan B on March 10, 2011 - 12:14

    Interestingly the power of the placebo effect and its widespread use in medicine was highlighted in research published earlier this week:

    http://www.guardian.co.uk/science/2011/mar/06/half-german-doctors-prescribe-placebos

    The standard ‘Skeptic’ line on evidence about homeopathy is that it is ‘no more effective than placebo’, skillfully ignoring the point that placebos clearly are effective.

    However, I’ve yet to read of any skeptic who has really engaged with the key issue which is that to be effective, patients probably have to have ‘faith’ in the placebo, and to be unaware that it has no proven physiological effect.

    So the real question is whether it is ethically acceptable for a doctor to prescribe something for which they have no evidence of effectiveness, if they also know it is harmless in the expectation that the psychological effect for the patient will be beneficial and to withhold that information from the patient because it’s in his or her best interests. I think it is, though it would be interesting to hear a skeptic’s view instead of the usual shouts of ‘woo’ (whatever that means….).

    Oh and NHS Wirral will almost certainly be funding conventional drugs that increase the likelihood that patients die (anti-psychotics that are given to people with dementia), just as Boots sell conventional cough and cold remedies that don’t work; it’s not as straightforward as you’d like to believe, and homeopathy is an area of ‘treatment’ where the NHS at least does very little harm….

  3. #3 by Marsh on March 10, 2011 - 12:47

    Hi Jonathan

    Thanks for your response.

    I think, actually, the ‘Skeptic line’ on homeopathy is not that placebos are ineffective (nobody has said they are not, indeed doctors and skeptics are the ones who make the biggest case for the power of placebo – homeopaths routinely attribute placebo effects to homeopathic pills!). The skeptic ‘line’ on placebo is that placebos are present in all manner of interventions… including effective medical treatments. Why choose simply placebo, when you can choose placebo plus proven medical benefits? We’ve made this point extensively.

    Similarly, we’ve made the point that patients don’t at all have to have ‘faith’ in the placebo (studies show placebos work even where the patient is told it’s a placebo, if told so in the right way – ethical placebo use). Check out Fair Deal Homeopathy, for example – ‘this is a placebo, but many people find it an effective activation of the placebo effect’.

    As for the real question, again this has been covered – not only by skeptics but by the Science and Technology Committee, by the West Kent PCT review and by countless ethics panels. For a doctor to prescribe something they know to be of no effectiveness damages the patient-doctor trust (a point made prominent in the Wirral PEC’s report linked at the top of this article), as well as recalling us to a time where medical decisions were made based on expertise over evidence, and where a paternalistic approach to care saw doctors keeping patients in the dark in order to best serve the patient’s interests. What becomes of patient choice, let alone informed choice and informed consent, in such an environment?

    Those are the usual arguments of a skeptic, if you engage with them on the subject – reports of the shouts of ‘woo’ are the preserve of those who clearly haven’t attempted to enter into dialogue. I think it’s utterly important for skeptics to talk to homeopaths (and I routinely do so, in a respectful and polite way – as I did last night), and only wish it was equally important to homeopaths to try to really understand the views of those who disagree with them, rather than simply labelling opponents as ‘arrogant scientismists’, calling Big Pharma conspiracy and shifting the goalposts. Which leads me to…

    NHS Wirral funds drugs that you state increase the likelihood of patients dying – I’m not sure about the example you state, as I’ve not looked into it. If indeed you’re right (and I’m not doubting you, I simply haven’t looked into it), why do you believe I’d want the NHS to continue such practices? You’re assuming that because I’m against funding for homeopathy, I’m for funding anything that’s ‘conventional’, and you’re making that assumption based on nothing. Similarly with Boots – homeopathy is not the only ineffective product they sell (a magnet to cure menopause symptoms and cough mixtures with benefits in line with placebo come to mind), and I’d like them to get rid of those too.

    So, then, it is pretty straightforward – regardless of how much harm is involved, if the policy for the NHS, for GPs and for pharmacies is ‘support only that which can be shown to be effective without the need for misleading patients’ then the policy acts as a catch-all, to remove all modalities that are not helpful for patients, but are continued for (among other reasons) the profit of big pharmaceutical companies, big homeopathic companies and big pharmacy chains.

    Marsh

  4. #4 by Xtaldave on March 10, 2011 - 13:39

    “whether it is ethically acceptable for a doctor to prescribe something for which they have no evidence of effectiveness (placebo)”

    This is a much more interesting question than “does homeopathy work” — which it clearly does not, beyond that of a placebo.

    So we can re-phrase this question as follows:

    “Is it ok for a physician to prescribe a placebo?”
    — Personally, I don’t think so. This involves deceiving the patient and would clearly go against current thinking that tries to encourage the patient to have a more active and informed role in the choice of their treatment.

    Doctors handing out placebos strikes me as a much more patriarchal, victorian-GP-smoking-a-pipe-handing-out-tintures-of-opium type of system.

    It is also inevitable that eventually some poor sod with a genuine life-threatening illness would be prescribed a placebo by their overworked GP and, in absence of effective treatment, die. Is this acceptable to anyone? Don’t get me wrong, doctors make mistakes, and patients die from those mistakes, but to open up yet another route for this is exactly the sort of thing we would surely seek to avoid.

  5. #5 by Jonathan B on March 10, 2011 - 20:05

    Marsh,

    The Placebo effect may indeed be ‘present in all manner of interventions’, but I’d argue that if that includes a treatment with ‘proven medical benefit’, it ceases to be a placebo as it’s usually defined. The evidence of the placebo effect where the patient is told they’re receiving a placebo is interesting, but not really conclusive (the ’Placebos without Deception’ experiment is actually rather dubious) and on balance, most of the evidence is that patients do need to ‘believe in’ the treatment for it to be effective (though in all fairness, most research doesn’t look at ‘how’ placebos actually work). The Fair Deal Homeopathy site is quite a clever piece of satire, but is nonetheless a spoof (I don’t imagine you were taken in…).

    I think your view of medicine is incredibly naïve, to be honest: in practice, medical decisions have always been based as much on art as science. Most people who go to GPs are looking for sympathy and reassurance as much as anything else, and placebos/homeopathy/alternative therapy are legitimate tools available to doctors in their real purpose which is as often about making patients ‘feel better’ as it is about ‘curing’.

    The ethical question is a difficult one: suppose I want a doctor to be paternalistic and keep me in the dark if s/he thinks it’s in my best interests? The reality is that the doctor/patient relationship is rarely as straightforward and clinical as your view implies.

    The point about anti-psychotics and dementia (the research was by Prof. Sube Banerjee and published by the DoH) is this: there are examples of bad medical practice causing immense harm (avoidable death is about as harmful as you can get). Another is the over-prescription of antibiotics which may have been a factor in the development of antibiotic resistant strains of bacteria. And I would add most cosmetic surgery to the list. By comparison, homeopathy does no harm when used within ethical guidelines.

    Personally, I’ve never taken a homeopathic remedy, nor would I advise anyone else to do so; I do know a lot of people who are convinced that homeopathy and other ‘alternative therapies’ make them feel ‘better’ and I don’t see that the benefits of ‘enlightening’ them justify the risk of making them feel worse.

    My problem with the Skeptic campaign against homeopathy is this: you may well agree that using anti-psychotics to control dementia is a bad thing, and you may well accept that Boots selling conventional cough and cold medicine is wrong, but you don’t campaign about anything other than homeopathy in the NHS and you don’t picket Boots to stop them selling cold cures (or for that matter, profiting from the belief of gullible blokes in the power of the ‘Lynx effect’). I suspect that’s because what you really care about is promoting ‘science’ over ‘superstition’. This is perfectly legitimate, but it isn’t necessarily very relevant to the task of making sure that medicine does good rather than harm.
    All the Best
    Jonathan

  6. #6 by malvickers on March 11, 2011 - 01:09

    I’ve looked into the writings of Samuel Hahnemann, it appears that he did know about placebo-controlled experiments.
    I’ve written a blog post about it:

    http://vicskeptics.wordpress.com/2011/03/08/the-writings-of-samuel-hahnemann/

    Also did you know?
    Hahnemann’s methods might persist today but his strange ideas about “miasms” and “psora” are forgotten.
    Hahnemann loudly condemned the drinking of tea and coffee.

  7. #7 by Sel on March 11, 2011 - 07:25

    Sorry, have to say something here. Yes many of the drugs we use can cause side effects, but when the accumulated evidence shows significant risks then as doctors, we are advised to stop their use. This is the case with the new generation anti-psychotics and specific types of dementia. By the way, they are not being used to treat dementia, but to treat psychotic symptoms which arise in a small number of patients with dementia. We are now actively changing these patients to safer drugs based on the evidence. I agree antibiotics do get overused, but can you imagine a world without them now? We do try to limit their use as much as possible, but waiting for cultures which can take several days is just not practical in all cases, and we have to make a best guess. Having had a close family member recently recover from meningococcal septicaemia, I consider antibiotic use very much the lesser of 2 evils.

  8. #8 by Jonathan B on March 11, 2011 - 08:55

    Sel,
    I accept that (some) many doctors are trying to reduce the use of anti-psychotics in dementia and know that advice has been issued to withdraw them (though I’m not sure that saying they are being used to treat ‘psychotic symptoms’ is quite accurate).

    My point was partly that changing prescribing practice where it is dangerous is often very difficult but more importantly that sorting out this kind of problem should be the priority rather than the debate about homeopathy which is primarily about ‘politics’ and which does no proven harm.

    I certainly recognise the importance of antibiotics and have seen their immense value; the whole point is that their value is not undermined. I’ve seen them being prescribed far too readily in the past and also seen the consequences of the emergence of resistant strains. There is also some research out there that suggests they have sometimes been used in effect as a placebo.

    My main argument was not ‘anti-medicine’ or ‘anti-doctor’: I was pointing out that given the challenges facing the NHS and medicine generally, homeopathy is a trivial issue and a philosphically motivated debate about it is an irrelevant distraction from the real priorities.

    Jonathan

  9. #9 by Andy Wilson on March 11, 2011 - 16:19

    Hi Jonathan

    “in practice, medical decisions have always been based as much on art as science. Most people who go to GPs are looking for sympathy and reassurance as much as anything else, and placebos/homeopathy/alternative therapy are legitimate tools available to doctors in their real purpose which is as often about making patients ‘feel better’ as it is about ‘curing’.

    So what are we saying here? That a Doctor has carte blanche to prescribe anything? Would a weekend away in a nice spa be an effective intervention for a cancer patient if the Doctor thinks so? What if the Doctor decided this patient should “pull herself together” and get on with it?

    The reality is that the Doctor chooses from a pre-selected armoury if a therapeutic intervention is required. When populating that armoury with my tax payer pound my fellow citizens and tax payers deserve value. Homeopathy has been shown to be therapeutically ineffective. If we were talking about the treatment of diabetes and a new drug came on the market with no demonstrable effects beyond placebo what would we say while the patients were dying around us?

    I get the point you’re making about placebo. Everyone gets that. It’s not in debate that placebo can help people feel better. Just like a nice cuddle does when you’re feeling down.

    If homeopathy were invented now it wouldn’t stand a chance of getting onto the NHS.

    Doctors don’t need sugar pills to make people feel better.

  10. #10 by John Cook on March 11, 2011 - 19:16

    I don’t normally respond to remarks about me in blogs and shall probably regret doing so now, but I did enjoy your account of, and the subsequent comments on the Wirral Homeopathy meeting in which I participated as Chairman of the North West Friends of Homeopathy. What I was trying to say in my joke about the Merseyside skeptics’ ‘dyslexic’ misprint of the date of the meeting (the 9th was incorrectly typed as the 6th) was that perhaps their members came to the meeting on the right day, as a result of a ‘dylexic’ read-back of the 6th as being the 9th. If I’ve offended any dyslexia sufferers (whether or not members of Merseyside skeptics) my apologies; I for one (and maybe only one) still think it was quite a good joke!

    In the same vein, thank you for the spelling corrections including of ‘RTC’ to ‘RCT’. I regard this as a spoonerism on my part rather than anything else but whatever cap fits I’ll grin and bear it. In the same spirit of assistance, in your report please note the correct spelling of ‘Charity Commission’ (as in ‘commissioning’)

    You correctly set out the primary object of the North West Friends of Homeopathy ‘the relief of sickness by homeopathic medicine’. Homeopathy integrated into “mainstream” medical practice from qualified medical practitioners who have specialised in homeopathy is the basis of the service and we strongly support that.

    I do have my presentation notes, as circulated at the ‘public meeting’, in print format so you might as well have them (below – references duly corrected to ‘RCT’ ). I do agree it was an interesting evening but do deplore the way the way Wirral PCT announced it or rather didn’t, leaving me to have to do that myself on Radio Merseyside two days earlier, not without repetition….

    Yours sincerely
    John K.H. Cook
    Chairman North West Friends of Homeopathy

    WIRRAL HOMEOPATHY COMMISSIONING

    PROFESSIONAL AND EXECUTIVE COMMITTEE ‘PUBLIC MEETING’ 9th March 2011

    POINTS FROM JOHN K.H. COOK – CHAIRMAN NORTH WEST FRIENDS OF HOMEOPATHY

    North West Friends

    – Small Registered Charity supporting Patients

    Homeopathy in North-West Area (including Wirral)

    – Established ‘Front Line’ Service on NHS since 1948
    – Homeopathy explicitly brought into the NHS
    – Qualified doctors who specialise in integrating homeopathy with
    “mainstream” medicine
    – Old Swan Centre Liverpool
    – Wirral local Outreach Centre at St Caths Birkenhead

    – Any change in the homeopathy provision in Wirral is ‘substantial’

    – Population of Wirral 330,000
    – 10% each year of the UK population use Homeopathy (per
    Medicines and Healthcare Regulatory Agency)
    – Huge Wirral vested interest in retention of the service
    – Not all need to use this established and popular service
    – Any one might need to use service in the future
    – patient choice
    – PEC have acknowledged it is a substantial change in Wirral
    – Taking to WMBC Health Overview Scrutiny Committee 22 Mar
    – (10 days before the recommendation to close)

    Consultation Process

    Professional Executive Committee’s Terms of Reference:

    – They’ve been charged with obligation to ‘champion public
    involvement’

    – Obligation to their ‘Parent’ the PCT
    – NHS Act 2006
    – World Class Commissioning Competencies
    – Local Wirral Compact
    – Local LINk

    – The PEC have failed on each test to consult meaningfully

    – Completely outside their own remit as a sub-committee to put
    for ratification or otherwise 29th March since the
    recommendation has been framed without due process.

    – Director of Communications & Engagement only informed by PEC
    of recommendation to cease 1/4/11 in January this year after
    it had been finalised (without consultation) by the PEC.

    PEC’s “recommendation document”

    Summary

    – Goes way beyond the question of who hosts the homeopathy
    provision and recommends no more homeopathic therapies for
    Wirral patients from 1st April 2011.

    – No indication of input of anyone specialising in Medical
    Homeopathy

    Assessment of evidence for Homeopathy

    – Has always been controversial

    – Science and Technology Committee Evidence Check quoted

    – “The government should stop the allowing of the funding of
    Homeopathy on the NHS” (para 110)”

    – 3 out of 14 members of the S & T Committee agreed with
    the report and 1 disagreed

    – The government rejected this conclusion (July 2010) (See A
    Attached)

    – Government notes the report’s strong focus on efficacy
    (ie based on RCTs) (para 2)

    – Government confirms (para 5) that commissioning of high
    quality services involves “.. a whole range of
    considerations including but not limited to efficacy”
    (RCTs).

    – Government acknowledges the existence of RCT evidence
    (para 24) that “.. there are peer reviewed reports that
    therefore have the support of some scientists that
    suggest there may be limited evidence of efficacy in
    certain circumstances”.

    – Despite the Department of Health’s rejection of the
    conclusion of the Evidence Check Report, Wirral PEC’s
    recommendation (para 8 ) says ‘there is no evidence that
    homeopathy works beyond the placebo effect’ which is
    another way of saying there is no evidence of efficacy’
    (RCTs) – which is wrong, because there is.

    – The government have rejected this conclusion as shown
    above. Whilst there is always need for more research,
    there is good scientific evidence in RCTs that homeopathy
    works and the government have acknowledged this.

    – For a detailed assessment of that evidence see the BHA’s
    website (see Attachment B) and their own response to the
    Science and Technology Committee Report. This was
    communicated to the Chair and CEO of Wirral PCT in 2010
    shortly after the Evidence Check Report came out and it
    also has been ignored by the PEC in framing their
    recommendation.

    Cost effectiveness

    – Compares the relative costs and outcomes (effects) of two or more
    courses of action.

    – Wirral PEC haven’t even started to consider this before
    coming to their recommendation. They have simply said
    because of no evidence of efficacy (wrong) they do not
    need to consider cost effectiveness of the service in
    Wirral (non-sequitur).

    Equality Impact Assessment (see template page 3/6)

    – Requirement: “Policy maker must screen all new policies for
    their impact on disadvantaged groups.”

    – PEC Conclusion: “There is a lack of evidence on the efficacy
    and cost-effectiveness of homeopathic therapies, therefore
    measuring the positive or negative impact is inappropriate at
    this time.” (Wrong, a non-sequitur and an insult to the
    residents of Wirral)

    Final point:

    Recent outcome survey by Liverpool PCT of their Homeopathic Service
    (Based on throughput November and December 2010)

    Excellent 80%
    Very Good 14.6%
    Good 3.6%
    Very Poor 1 out of 165 responses.

    Conclusion
    The PEC’s Report of 18th January 2011 should be withdrawn forthwith.

    John K.H. Cook
    Chairman
    North West Friends of Homeopathy
    Registered Charity 282281
    9th March 2011

    Note – attachments referred to above:

    Attachment A: Print of paras 1 -5 plus para 24 of Government response
    (July 2010) to S&T Evidence Check. From government full response:

    http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117811.pdf

    Attachment B: screen print of British Homeopathic Association front
    Research webpage (as notified to Chair and CEO of Wirral PCT in 2010)

    http://www.britishhomeopathic.org/research/

  11. #11 by Jonathan B on March 11, 2011 - 22:57

    Andy,
    No of course I’m not saying that doctors can prescribe anything.

    However, your implied view of medicine as a purely empirical process of selecting proven therapies to treat conditions of which the clinician has a complete and perfect knowledge bears very little relation to the reality.

    Most doctors, especially GPs, spend a lot of their time dealing with fairly nebulous conditions such as stress, anxiety, depression and unspecified pain and these necessitate a response that is not simply a technical process of diagnosis and treatment. In these cases, there may be an identifiable condition that wll respond to a conventional treatment, but there may not, and if homeopathy (or anything else) makes people feel better if they believe in it, and there are no detrimental side effects, why not use it?

    The comparison with diabetes doesn’t hold water because it is a condition for which there are proven treatments.

    The evidence for most of the so-called ‘talking therapies’ (counselling, CBT et cetera) is far from conclusive (they appear to help some people but may harm others) and they’re very expensive; they also rely on ‘trust’ or ‘faith’ in the practitioner just as placebo does. But of course, they’re not considered ‘woo’.

    And with all due respect, I don’t think you do ‘get the point’ about placebo: so at the risk of going over old ground, placebo is widely used, often more effective than ‘no treatment’ and (probably) relies on the patient being ignorant that their ‘treatment’ has no proven effect to be useful.

    To say that homeopathy is ‘no more effective than placebo’ is actually to say that ‘homeopathy is sometimes effective’.

    Having worked in the NHS, I’m as happy for my taxpayer pound to be spent on homeopathy as many of the other things it goes on, and frankly happier to see it spent on that than some things in the budgets (grossly expensive IT systems that don’t work, for example….).

  12. #12 by Andy Wilson on March 12, 2011 - 16:14

    “To say that homeopathy is ‘no more effective than placebo’ is actually to say that ‘homeopathy is sometimes effective’”

    Yes it is. But only to the extent that placebo can be. There is no demonstrable therapeutic effect. So this placebo effect has a “maximum” effect, as it were.

    You seem to be arguing for the routine availability of placebos. Is this correct?

    Using homeopathy for this purpose would be damaging to the doctor patient relationship as homeopathy pretends to have a therapeutic effect and these historical claims sully it for use in this way, as a whole belief system must be supported by the Doctor.

    I think I do “get the point” about placebos. I don’t agree with the paternalistic care outlook, which I think you have some sympathy with. But homeopathy is not a good answer to that question.

  13. #13 by Jonathan B on March 16, 2011 - 22:22

    Andy,
    I’m not sure I understand your point about placebos – mine was that placebos do have a ‘demonstrable therapeutic effect’. Of course any treatment (including placebo) has a ‘maximum therapeutic effect’… so an antibiotic will treat a bacterial infection, but won’t deal with a viral one.

    I certainly wouldn’t argue for the ‘routine’ use of placebos, but I do believe that they have value if used judiciously, and the German research suggests that they are actually used very widely.

    Yes, I probably do have some sympathy for a ‘paternalistic’ approach to care, based both on experience as a patient and professionally, though I don’t think that it should be rigid or imposed: my personal view is that sometimes Doctors can legitimately decide that it is in the patients best interests not to be told everything that they might be told (if the patient asks, that’s a different matter, of course). And the reality is that Doctor-Patient relationships generally tend to have an element of that in many cases.

    Once again, I’d ask what the harm is in using something that makes some people feel better (if they believe in it), especially given that there are quite clearly no potential side effects.

    All the Best,
    J

(will not be published)