As I’ve covered previously, the position of homeopathy on the NHS in the Wirral region has been under review, with the Professional Executive Committee evaluating the future continuation of the 200-year-old non-science in the wake of dwindling patient interest.
Following the open meeting of March 10th to discuss proposals to cut homeopathy from the budget, the PEC collected their thoughts and formally presented them to the Wirral NHS Board. This meeting took place on the 22 March 2011, and unsurprisingly attracted the attention of the North West ‘Friends’ of Homeopathy, whose very vocal envoy John Cook persuaded the board to allow him to present his objections to their proposal. Readers of the previous blog or listeners to Skeptics with a K will know John well, and his forthright advocacy style.
Fortunately, a local councillor is a supporter and friend of the MSS, and he was able to equally persuade the board to allow an external voice of support into the meeting to counter the objections of the homeopathic lobby – which is why I found myself called upon to give a 5-minute speech in favour of disposing with the sugar pills once and for all.
The exact text of the speech is presented below, and my opportunity to present it came immediately after 5 minutes from the homeopaths, in which the main thrust of their argument was:
- The consultation process had not been as robust as one would hope (essentially attempting to get off on a technicality)
- Homeopathy does indeed work and there is science to prove it
- Homeopathy is used by 10% of the population (a somewhat spurious figure brilliantly put into context by the board, who pointed out that the 60 affected patients in the Wirral each year are in fact just 0.02% of the population)
- Those who seek to end funding for homeopathy are in fact attempting to ban it, with similar zeal to the calls to rid the world from smallpox.
I’ve no doubt that John will be able to offer a fuller clarification of these points below, and I welcome him doing so if he so wishes. Following this argument, I took to the rather official-looking table with it’s little microphone, the eyes of the board upon me, and began:
I was made aware of this meeting today by Councillor Darren Dodd, councillor for Liscard, because I represent a voluntary group with interests in promoting evidence-based, rational healthcare practices, who are very much in favour of the proposals to relieve NHS Wirral of the burden of funding homeopathy.
It was said in evidence submitted to the Science and Technology Report Evidence Check on homeopathy – the report which, I dare say, was very much the precursor to the proposals put forward to cease funding for homeopathy from the NHS Wirral budget – that efficacy is not the be-all and end-all when it comes to treatment modalities such as homeopathy. Here, I believe, we agree, given that patient choice and cost-effectiveness are also clear and important factors in deciding whether or not to fund any particular modality. However, cost-effectiveness and patient choice in isolation can’t provide a solid base for the provision of a certain treatment – fundamentally, and as a baseline, it’s vital that any proposed treatment works. Without proof a treatment works, cost-effectiveness becomes a moot point – how cost-effective can a clinically-ineffective treatment be?
Similarly, without reliable evidence that a treatment can work, the notion of patient choice is nonsensical. It is absurd to offer patients the choice of an intervention which is not known to effectively treat their condition. In fact, that the very offer of homeopathy is available is likely to be taken as an implicit endorsement of that intervention. Patients do not expect to be offered ineffective treatments by the NHS; the understandable assumption will be that if the NHS funds it, it must work. At best, this is misleading.
Despite claims from retailers of homeopathy, friends of homeopathy, and spokespersons for multinational homeopathic pharmaceutical companies (of which members of least one of those groups and possible all three we’ve heard from tonight), despite their claims that homeopathy is based on good science, the evidence from clinical studies is clear: homeopathy does not work above the placebo effect. This meeting, of course, is not the forum to debate the intricacies of individual studies into the efficacy or otherwise of homeopathic remedies, and I believe this has already taken place – not only in the aforementioned Science and Technology Report, but in a myriad of other clinical trials and assessments. However, a quick summary can be useful: looking at the literature, a pattern is clear – where studies are objectively and independently assessed as being the fairest tests with the best methodologies, the effect of homeopathy diminishes to zero. Were a pharmaceutical drug to have the history of shoddy research and weak evidence which homeopathic remedies thus far have shown, it wouldn’t be considered even for a moment to be funded on the NHS. Quite why homeopathy has enjoyed special privilege is very much an artefact not of its efficacy, but it’s antiquity – the founding body of the NHS happening to have included at the time a homeopath. The favouritism towards this particular modality over the myriad of other disproven techniques and systems is now reaching something of an end – with PCTs across the country shedding homeopathic contracts from their books. It’s encouraging in the extreme to see calls from NHS Wirral to follow suit.
This isn’t to say we seek to ban homeopathy entirely – in fact, if proponents of homeopathy were able to reliably demonstrate that their remedies have genuine effects, then they may be worth considering in the future. As yet, such proof hasn’t been forthcoming, nor does it look likely to appear any time in the future – particularly given that the giants of the multi-million pound homeopathy industry still spend around twenty times as much money advertising their products as they put into researching whether they actually work – a figure which makes even the horrendous excesses of the Pharmaceutical industry seem comparatively professional. We should absolutely keep an open mind, but we should be sure to temper it with a critical eye. The time for NHS Wirral to offer homeopathy is after it can be shown to have genuine, reliable and objectively measurable effects – not before.
It’s worth noting that we’re quite famously in an age of austerity, with budgetary pressures doubtless being felt throughout the NHS. Given that we know there are treatments which are proven to work, but lie unfortunately outside of the financial constraints of the health service at this time, now is the perfect time to remove funding for the treatments – such as homeopathy – which are at best unproven, and at worst comprehensively disproven.
I’ve since heard that the doctors in attendance were nodding in agreement throughout, which is great to hear.
Given all of the above, and more evidence from the doctors, it’s with great delight that I can let you know that the PEC voted to scrap homeopathy from the NHS in the Wirral, with the dwindling numbers of existing patients able to see out the course of their treatment, but no new patients to be taken on. This, we have to consider, is a great victory for our campaign, and for common sense.