Homeopathy in the Wirral: RIP


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.

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  1. #1 by Rhys on April 2, 2011 - 12:20

    That smallpox point is extremely random, but at least he’s comparing one bad thing (homeopathy) to another bad thing (smallpox).

  2. #2 by Gordie Cavill on April 2, 2011 - 12:29

    Fantastic news, I was holding out little hope for common sense until I read this.

    This woowaa treatment has been proven ineffective, unscientific and dangerous time and time again and it truly saddens me that in our modern world charlatans and snake oil merchants are allowed to peddle this rubbish.

  3. #3 by Richard on April 2, 2011 - 12:56

    Hurrah! Well done!

  4. #4 by Timlin on April 2, 2011 - 13:01

    Science-1 Magic-Nil

  5. #5 by Tom Williamson on April 2, 2011 - 13:19

    Fantastic stuff, great work. Have they publicly announced their decision?

  6. #6 by Charlie Chesser on April 2, 2011 - 15:24

    Are things going similarly with other PECs?

  7. #7 by polomint38 on April 2, 2011 - 18:56

    The distressing thing is that we have to argue this time after time. Just look at the evidence people.

  8. #8 by Jake Archibald on April 2, 2011 - 23:45

    Fantastic speech & congrats at the result. I hope the rest of the PCTs have similar meetings.

  9. #9 by lt_zippy2 on April 3, 2011 - 09:35

    Great news…now (for entertainment purposes only) I’m looking forward to the reaction from the woo-crowd, sorry the “Friends of Homeopathy!

  10. #10 by John Cook on April 3, 2011 - 10:08

    Thank you for your invitation for me ‘to comment below’. The links to the evidence are already covered in my previous contribution (#10 in your ‘as I’ve covered previously’ link, which you kindly included in full).

    The nub of the Homeopathy-in- the-NHS-or-not debate is that it was fought for and obtained explicit acceptance in 1948 when the NHS started. Yes there were ‘skeptics’ (whatever the spelling) around those days too. It’s hardly surprising if the founding body of the NHS ‘included a homeopath’ because, then as now qualified medical practitioners can and do choose to train and specialise in homeopathy, which then and now deserves its place in our ‘comprehensive’ NHS.

    60 years on and medical knowledge has advanced but the rationale for the original NHS acceptance remains intact. This is not to say that it is never right to question such acceptance and there’s a good chance there will be comments above and below this entry doing just that. There was a time when cigarettes were widely ‘believed’ to be therapeutically generally good for your health but I for one would be on the other side of a debate for the ‘commissioning of cigarettes’ by Wirral PCT!

    What’s different about homeopathy (compared with my admittedly rather extreme cigarette example) is that study after study (including the recent Liverpool study) show that homeopathy can be good for your health in circumstances where “mainstream” medicine on its own has failed, leaving people in chronic bad health, as well as being a financial drag on the NHS, so I continue to support very strongly the case for continued commissioning of homeopathic therapies safely from the available pool of medical experts in the Merseyside area, including my home patch the Wirral. It’s a win win situation to be able to continue these therapies integrated with “mainstream” medicine in this way.

    I won’t use your column to rant on about consultation issues (though I could and no doubt will elsewhere) but the thing that gets up my nose about the NHS Wirral proposal is the explicit and exclusive latching onto issues of ‘efficacy’ rather than effectiveness as the ultimate determinant for decommissioning an established service. It’s quite irrational in my view to get rid of something which can be shown to be therapeutically beneficial on the basis of the House of Commons ‘evidence check’ report which as the NHS Minister (in rejecting the call for a ban on NHS homeopathy) points out (Para 2) in the response to the report is ‘heavily focused on efficacy’ rather than effectiveness.

    Furthermore the NHS has pledged (2008) “Existing services will not be withdrawn until new and better services are available to patients so they can see the difference.” Wirral PCT has simply ‘polished off’ that pledge (hint: there’s a joke in there!)

    I leave aside the questions of the contributing factors as to why homeopathic therapies remain so effective (? the products per se – with their extensive range and potencies; ? the mode of dispensing; ? the belief factor of the many supporters of homeopathy;) not because these questions are uninteresting, quite the contrary, but because they are irrelevant to rational decommissioning decisions, the impact of a decision on those existing and future patients’ health outcomes is what matters.

    Yours sincerely

    John Cook

    Chairman
    North West Friends of Homeopathy

  11. #11 by Adam Lappin on April 3, 2011 - 16:55

    Hi John,

    ‘Efficacy’ is simply a word to describe if something is effective at accomplishing something. If you state that a report shows the efficacy of homeopathy to be nil, it means its not effective (ie, it doesn’t work).

    To claim that the efficacy of homeopathy is not supported but that it is effective is a nonsensical statement.

    The explanation of why homeopathy works makes as much sense as the argument to have it on the NHS. I’m glad that the money previously spent on medical that doesn’t work will be available for more effective treatments.

    Yours sincerely,

    Adam

  12. #12 by Marc Johnston on April 3, 2011 - 21:53

    At last a victory for common sense.

  13. #13 by Michael on April 5, 2011 - 10:39

    John by ‘New and better services’ do you mean “Ones that actually work” instead of ‘wishful thinking and bullshit magic’. Claims that ‘It worked for me’ are useless. I had a pain in my neck. I rubbed a piece of bacon on the area. I placed the bacon at the end of the garden. Within half an hour a seagull took away the bacon. The next day my pain was gone. The pain went into the bacon and the bacon was devoured by the gull. Bacon is cheaper than homeopathic magic water. So this should be used on the NHS. It worked for me.

  14. #14 by Nick Smith on April 5, 2011 - 23:33

    Science is King, which is all very well until the new king comes along and it all changes. You only have to look at the development of current medical “science” to see that its wasn’t that long ago that blood letting and leeches were prime therapies. It’s also clear that despite the advances there is still a long, long way to go. The recent 10:23 campaign says it all homeopathy doesn’t kill people, lets see some of those campaigners try a similar experiment with some of the products the pharmaceutical industry would have us believe we need to cure us, or rather mask our symptoms. Homeopathy is an important part of the NHS, a safe and cost effective way of treating many of those people with chronic conditions.

  15. #15 by Johan Strandberg on April 6, 2011 - 07:36

    Nick Smith :
    Science is King, which is all very well until the new king comes along and it all changes. You only have to look at the development of current medical “science” to see that its wasn’t that long ago that blood letting and leeches were prime therapies. [...]

    Dear Nick,

    I think you will find that leaches are still covered by the NHS since they are used in modern medicine. Remember, alternative medicine that works has a technical name: medicine.

    As for your comment that 10:23 showed that ” homeopathy doesn’t kill people” is true, that was not the purpose of the campaign as I understand it. The 10:23 events are not scientific studies claiming to prove anything. They are theater to get the press to show up so the important part will be heard and written about. The true purpose was to educate and raise awareness how a few believers in magic have diverted precious resources originally target for medical care, so that a few merchants and so called “practitioners” can make a buck.

    What makes us so certain the “theory of homeopathy” is not science, is our thorough understanding of basic physics and chemistry. We actually know, with the same level of certainty that we know that the sun will rise tomorrow, what happens when you dilute something. If you dilute it enough, there is nothing left. Nothing. No magic water, no molecules of the original tincture, nothing. Just water. Shaken, not stirred.

    If we didn’t understand this, then the computer that you read this on would not, could not, exist. Its very construction requires creating ultra pure slabs of crystals and then “dope” them with a few carefully selected atoms to distort the lattice “just-so”.

    I will defend your right to believe in magic, but if you use magic to treat others, sap resources from people in need, or teach magic to our children, then I will fight you all the way.

    May I suggest taking a class in physics/chemistry? If we are wrong, you can show us how to improve modern medicine. Science can always be improved, and you learn something else, you’ll have use for that too. All that money wasted on homeopathy might even pay for the class.

    –j

  16. #16 by Peter on April 6, 2011 - 12:34

    Dear John,
    If you pop over to :www.quack watch.com , seek out the homeopathy section;you’ll find an article from an Australian
    chap debunking homeopathy in an hilarious way.
    And while you’re at it read about all the other forms of quackery listed there.
    I once had a girl friend who practiced reflexology!
    When I burst out laughing she labelled me ignorant!
    I countered her accusation by asking her to describe the circulTion of the blood.
    She couldn’t!
    It’s in the “bullshit baffles brains category”

  17. #17 by Nick Smith on April 6, 2011 - 23:30

    Dear John,

    A biologist, a physicist and a mathematician are on a train in Scotland. The biologist looks out of the window, sees a black sheep standing in a field, and remarks, “How odd. Scottish sheep are black.” “No, no, no!” says the physicist. “Only some Scottish sheep are black.” The mathematician rolls his eyes at his companions’ muddled thinking and says, “In Scotland, there is at least one sheep, at least one side of which is black.”

    For a supposed sceptic you are surprisingly willing to accept science as truth without questioning its limits. I’m glad you think I would benefit from chemistry or physics classes; I did indeed study both of these subjects many years ago as part of my degree course. The most important lesson was learning to question.

    Sadly, medicine rarely involves simple or even straight forward chemistry of physics rather it has to deal with a very complex organic system, not only that it’s a system that capable or rational or at times completely irrational thought.

    I recently underwent chemotherapy treatment, none of the oncology staff could predict how I would react to the chemo drugs, what the side effects would be or even if it would actually work despite all the supposed scientific evidence at their disposal. (I was on a standard regime, using drugs that had been used in cancer treatment for about 40 years) What I was presented with was combined anecdotal evidence from previous patients. I was happy to accept this as even with my limited understanding of human physiology I can understand the large amount of variable involved in body chemistry.

    And this is the main issue; science does not have all the answers. I don’t believe in magic. I’m happy to accept that Homeopathy helps people, particularly those with chronic conditions based on anecdotal evidence. If it helps people it should be available as part of the range of services provided by the NHS. Personally I don’t care how it works, water “memory”, placebo effect or even shamanism. I’m even content in the knowledge that it doesn’t work for everyone, but then neither does conventional medicine (two of the people undergoing treatment at the same time and for the same condition of me died).

    Following last years BMA conference a DoH statement said: ‘Although we don’t hold central data on spending on homeopathy across the NHS, we do know that the cost of homeopathic prescription is a tiny fraction (approximately 0.001%) of the overall drugs bill of £11,378 million. If you are rightly worried about use of limited resources in the NHS, there a many many other area for you to campaign about that don’t affect patients services, GP salaries, getting rid of the internal market, even infrastructural changes like energy efficiency.

  18. #18 by Johan Strandberg on April 8, 2011 - 04:41

    Dear Nick,

    Are you posting #17 in reply to me? My name is not John but I guess it is close enough [I have been called worse].

    You write:

    [...] For a supposed sceptic you are surprisingly willing to accept science as truth without questioning its limits. I’m glad you think I would benefit from chemistry or physics classes; I did indeed study both of these subjects many years ago as part of my degree course. The most important lesson was learning to question.[...]

    I’m sad to see that such an essential part of the course material was left out in the classes you took. Science is not a matter of truth, it is a method of asymptotically approaching a truth (unless we are talking mathematics, in which case there are four lights, not five.)

    That said, diluting liquids is actually a case that gets about as close to mathematics as physics is capable of. There is no need for “very complex organic systems” or “[...] at times completely irrational thought” and above all, no need for anecdotal evidence.

    Dilution works the way science describes it, even if your mother told you differently.

    I think you should demand a refund for the time and money you spent studying chemistry and physics. Clearly you got duped.

    As for the anecdotal part of your comment, all I can say is that I wish you the best of health and a long life. Maybe some day we can sit down over a pint and talk about that and the many other things outside of the domain of science that some of us call life. Prost!

  19. #19 by Nick Smith on April 8, 2011 - 17:48

    Johan,

    I do apologise for my previous error, I meant no offence. I am now wearing my glasses (I need to put more faith in optics and less in vanity).

    I have no problem understanding physics or chemistry, my knowledge of the complex human physiology is a considerably less and that of human psychology even worse. Unfortunately medical treatments involve complex interactions between all of these.

    But my main point and one you chose to ignore is that Homeopathy works for some people, particularly those with chronic conditions. I make no claim about how it works. Again this is largely based on anecdotal evidence, and I made the point that an awful lot of medicine and current medical treatments are based on anecdotal evidence.

    Basically, the most important issue is the patient experience of homeopathy. If it helps people then it should be available as part of the NHS. It’s a very minor expense in the overall budget and provides a safe a cost effective method of treating many people with chronic conditions.

    You may want to use the sceptical part of your brain to consider that patients with long term chronic conditions are the ideal target for the pharmaceutical companies, long term reliance on patented drugs does wonders for profits. Maybe I’m just a little cynical.

  20. #20 by skepticarla on April 11, 2011 - 13:42

    Dear Nick,

    Your use of the term ‘chronic’ needs explaining. someone can have chronic back pain, which won’t kill them, or chronic renal failure, which will. Chronic just means over an extended period of time. Now homeopathy may appear to help someone with chronic back pain, temporarily, due to the placebo effect or the power of the mind but it won’t help someone with chronic kidney failure. Our best hope for conditions such as these is medicine, which as you know having undergone chemo, is science’s best current effort at treating such illnesses. As soon as science comes up with a better way of treating cancer (or whatever) then that will be freely avilable to us on the NHS (always hoping that the present government doesn’t get its way). Tax payers should not be funding homeopathy in any way, because IT DOESN’T WORK PAST PLACEBO. There is no medical evidence for it working, but if you wanted to go to your local health shop and buy it for yourself then go ahead.
    With the governmeent cutting 40,000 NHS jobs in plans announced today, we cannot afford to go on funding pseudoscience out of our taxes. If you want homeopathy then dig into your own pocket and pay for it, don’t expect the taxpayer to fund your placebo prop. (and I mean a general ‘you’ not you in particular Nick).
    I loathe this view of ‘Big Pharma’ as if they are all Mr Burns types rubbing their hands together with glee at all the sick people in the world.
    I agree that they make mistakes, and that they are profit driven, but do you know of any homeopaths who donate their time for free? That don’t make mistakes?
    The ‘woo’ industry rakes in millions every year whilst accusing ‘Big Pharma’ of money grabbing. If it wasn’t for big pharma, you wouldn’t have chemo, we wouldn’t have vaccines, painkillers, dialysis, better anaesthetics, transplants and all life saving treatments that we are privileged to have access to.
    Which world would you rather live in? The modern world of these incredible advancements, or the medieval world of pseudoscience where treatments ‘might’ work but won’t help anything serious?
    I know which one I would plump for…

  21. #21 by skepticarla on April 11, 2011 - 13:55

    And well done to the MSS for helping Wirral PCT to come to this decision. A win for critical thinking and common sense. Congratulations!

  22. #22 by Nick Smith on April 20, 2011 - 23:05

    Dear Skepticarla

    Ah medical evidence. The 2009 The British Medical Journal (BMJ) Best Health Project looked at 2500 commonly used medical treatments, 46% of these had no “scientific basis”, and their use was based on habit, doctors or patient preference. Worse 10% were unlikely to work, be ineffective or actually harmful. A review of data submitted to the US Food and Drug Agency in support of licensing application for antidepressants found that these were no better than placebo and if unpublished data was included there was no significant effect.

    So care is needed about the claims of scientific evidence in medicine.

    Just because we don’t know or can’t understand how something works mercifully doesn’t stop doctors using it. There is very little understanding of how anaesthetics work, but I for one are very glad that they do work.

    The most important aspect of any therapy is the patient’s experience, in the end that’s what it’s all about. A government funded project in Northern Ireland found positive benefits for some patients with a range of long term conditions when their GPs could refer them to complimentary and alternative therapies, including homeopathy. The project even found cost savings in a reduction in drug prescriptions and doctor’s time.

    You are right the NHS is under extreme financial pressure. The cost of homeopathy is minor in comparison to some of the spectacular wastages within the system, PFI for example. I think its wrong to target patient services such as homeopathy when there are other areas where saving could be made, or better still this Government could stick by its pre-election promises and leave the health service alone and raise money by simply closing a few tax loop holes.

  23. #23 by Sian on June 9, 2011 - 15:22

    I agree.
    Science does not understand everything. The interesting question is have the skeptics ever tried homeopathy? Probably not-so they rightly dismiss it as ‘total rubbish’ as it has ‘no scientific basis’.

    So-just because something has ‘no scientific basis’ should be stop it? Tell that to cancer patients who get administered placebos to stop their pain.

    For one, I don’t care if there is scientific evidence or not. Because of homeopathy I am able to live a medication free lifestyle.

    So we don’t have proof that homeopathy works-but that is missing the point, surely! If patients feels that it does work, surely any money saved, would be spend on needless drugs (more expensive) with possibly side effects (more expensive again)-so what possibly benefits are there in withdrawing this treatment. Other than, to make some kind of point, that ‘homeopathy is useless’!
    Those championing this point might want to reexamine their logic-given that homeopathy has been proved harmless.

  24. #24 by Mike on June 9, 2011 - 15:26

    Sian :

    I agree.
    Science does not understand everything. The interesting question is have the skeptics ever tried homeopathy?

    Yes, I was raised with it.

    Sian :

    So-just because something has ‘no scientific basis’ should be stop it?

    When it comes to medicine, yes.

    Sian :

    Those championing this point might want to reexamine their logic-given that homeopathy has been proved harmless.

    Harmless? Have you told that to the people who have died because they took homeopathy instead of going to a doctor? Oh, sorry, hold on. You can’t do that, they’re dead.

  25. #25 by Tim on June 16, 2011 - 18:37

    Sure, science doesn’t understand everything. I don’t know if I’ve ever heard someone claim that it does. But it seeks to, and that’s what matters. The point is that even if science can’t help us understand everything, there are certain things that it does help us understand.

    More often than not, science is about refining existing theories. Realizing that planets move in orbits, then realizing that those orbits are eliptical and not circular, and then realizing that they are held in place by gravity not ether . . . this is a progression of scientific knowledge. With the advent of quantum theory and all that fun stuff, scientists did not throw away Newtonian physics, because in most situations it still works fine. Progress is made by adding to, refining, and constantly re-validating pre-existing knowledge.

    When something like homeopathy comes along, something which is completely contrary to every known shred of scientific knowledge ever, I just don’t see how so many people can be in favour of using it as a legitimate treatment. And if they are using it to lead a “medication free lifestyle”, then there can’t really be anything wrong with them in the first place. Also, not having proof that homeopathy works is EXACTLY the point.

    As for the argument that there are plenty of other things that can be cut if the NHS is looking to save a few bucks, well, you have to start somewhere. No matter what you cut, you’ll get the same argument from that camp.

(will not be published)