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.

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.

The 10:23 Campaign

In light of the recommendation by Dr Margaret Somerville to end support for homeopathy on the NHS in Scotland, the 10:23 Campaign reiterate our stance that NHS support for this disproven quackery must be withdrawn immediately.

Speaking in response to an investigation by the BBC, which included the exposure of three homeopaths willing to treat patients with ineffective homeopathic ‘alternatives’ to the life-saving MMR vaccine, Dr Somerville described a “settled, clear and unambiguous clinical opinion” that homeopathy should not be used in the NHS and advised support be ended immediately – advice which has been taken on board by the NHS Highland, who opted to cease funding for the treatments today.

Michael Marshall, speaking on behalf of the 10:23 Campaign, today offered support for Dr Somerville’s statement:

“It’s immensely encouraging to see the Director of Public Health for the NHS Highland making so categorical and clear a statement, and to see the board follow through with decisive action. The evidence for the use of homeopathy is at best poor, and at worst non-existent. While belief may exist amongst practitioners that further studies are needed, such studies should be undertaken at their expense, rather than supporting the ineffective therapy with funding from taxpayer’s money in the meantime.

Speaking of the revelations in the BBC investigation, Mr Marshall continued:

“That the BBC found homeopaths willing to partake in some highly dubious and downright dangerous practices is little surprise to those of us familiar with the system of homeopathy. While homeopathic treatments themselves are often harmless – indeed, they’re chemically indistinguishable from simple sugar pills – the associated anti-scientific philosophy is often a breeding ground for poor health information and anti-vaccination propaganda.

This isn’t the first time such dangerous advice given by homeopaths has been exposed – a previous BBC investigation revealed homeopaths willing to offer ineffective replacements for anti-malarial drugs, and our own investigations have found countless tales of other homeopaths willing to offer treatments for AIDS, cancer and all manner of genuinely serious illnesses, based on no proof of efficacy and no reason to believe homeopathy to be useful.

This investigation didn’t reveal merely three rotten apples in an otherwise sound barrel, it exposed symptoms of a rotten system – teaching anti-science and actively promoting dangerous health information. It’s for these reasons that we applaud Dr Somerville, and all who similarly campaign for sense to triuph over nonsense, and it’s for these reasons that we strongly applaud the action from the NHS Highland and urge other areas of the NHS to follow suit”.

The 10:23 Campaign

On January 30th, 2010, at exactly 10:23am, large groups of skeptics will gather in the town centres of around a dozen cities in the UK and consume a full bottle of homeopathic pills, in order to demonstrate the ineffectiveness of homeopathy. Marsh explains why…

Homeopathy in the UK is alarmingly pervasive – setting aside the fact that the industry is worth an estimated £40million per year, the National Health Service actually plows £4million per year of taxpayers’ money into providing sugar pills as a Complementary Alternative Medicine – much of which goes into the upkeep of the four government-run homeopathic hospitals. That figure doesn’t even take into account the £20 million spent on the redevelopment of the Royal London Homeopathic Hospital. According to the British Homeopathy Association, more than 400 GPs regularly refer patients to homeopaths. Homeopathy is everywhere. And then we have the UK’s leading pharmacy, Boots…

Boots are as much a British national institution as the Royal family, the BBC and the sense of quiet superiority over our former colonies. Yet this well-respected and trusted organisation lends its well-earned reputation to quackery in the sale of homeopathic remedies (including it’s own-brand range) alongside real medicine. What’s more, their decision to stock these sugar pills is compounded by the fact that they have no real belief in their effectiveness, as became clear in the laugh-a-minute evidence check session, where Boots’ Professional Stand-up Com… sorry, Professional Standards Director Paul Bennett admitted the company’s policy of selling homeopathic remedies was based not on a belief that they work, but in a belief that they sell, and sell well. And that’s before we even take a look inside the Pandora’s box that is the Boots Learning Store – Alternative Medicine module (sample statement: ‘Foxglove (Digitalis) extract is used in the treatment of heart failure’).

Fortunately, homeopathy hasn’t been without its detractors and skeptical voices here in the UK – with David Colquhoun, Simon Singh & Edzard Ernst, James Randi (of course) and a whole range of other science writers and bloggers confronting homeopathy with sanity. Still, it’s not the science writers who have had the most success in getting information to the public of late – while having real science to hand is essential in helping dispense with the pseudoscience, it’s perhaps been the contributions of comedians and satirists that have had most success in spreading real information to the man on the street. For every Edzard Ernst picking apart the latest meta-analysis, we need a Dara Ó Briain telling the world ‘It’s just fecking water’; for every Quackometer showing where regulation is failing to keep homeopathy in check, we need a Mitchell & Webb to show us how ludicrous homeopathic healthcare actually is; for every Tim Farley answering the question ‘What’s The Harm?‘, we need a Tim Minchin asking the question ‘if water can remember a long lost drop of onion juice, how come it forgets all the poo it’s had in it?’ (the best answer to this, by the way, came from a satirist who claimed it was due to succussion: ‘As you beat the memory into the water, you beat the shit out of it’).

In short, the fight to raise awareness of homeopathy is best fought when everyone can bring what they have to the table, whether they’re ‘experts’ or otherwise. And this, essentially, was the inspiration behind the 10:23 campaign.

At the Merseyside Skeptics Society, we took inspiration from the success of the Australian Skeptics campaigning against ear candles via the publishing of an open letter, stealing the idea outright to pen An Open Letter To Alliance Boots appealing to them to remove homeopathic remedies from their shelves. From there, the 10:23 campaign grew – a website was launched with the aim to have a resource where people can go for basic information on homeopathy in simple, accessible English.

The goals of the 10:23 campaign are equally simple and accessible – to help raise awareness of what homeopathy is (and what it very much isn’t); to give individual writers and bloggers a banner and brand name to use when doing their day-to-day homeopathy-debunking, helping make their work easier to find and promote (do a quick search for #ten23 on Twitter and you’ll see what I mean); and to promote critical thinking to a wider audience.

As the campaign’s progressed, two questions have come up time and time again, and it’s probably a good idea to answer them now: ‘What’s next for the 10:23 campaign?’ and ‘Why is it called the 10:23 campaign anyway?’ I’ll answer the latter first… Yes, it is partly to do with the Avogadro constant. There are those that may think using this as the name for the campaign is something of an exclusive, scientific in-joke that would put off the non-science-savvy – here, I must disagree. Instead I believe it gives an opportunity to talk about the levels of dilution involved in homeopathy, and what effect they have on the ingredients of the sugar pills. What’s more, there’s more to the name than simply Avogadro, which leads me to the second questions…

On January 30th, 2010, at exactly 10:23am, large groups of skeptics will gather in the town centres of around a dozen cities in the UK and consume a full bottle of homeopathic pills, in order to demonstrate the ineffectiveness of homeopathy. Similar events will be taking place in the US, Canada and Australia. While the scientific evidence is there for people to find, we’re hoping this very public demonstration will help give people the motivation to go look for it.

Contact your nearest Skeptics in the Pub group for information about how to get involved. Organisers of local skeptical groups can email contact@1023.org.uk for more information. See you on January 30th!

The other day, I read Marsh’s latest post ‘Real Medicine: I Wonder’ with interest – as (hopefully!) one of the “good doctors” he wrote of, I would like to report all is well within the NHS. Unfortunately I can’t. Virtually all the comments on his piece were positive about the use of conventional medicine, but an important point was raised regarding the care of osteoarthritic hip pain. Currently the options for “wear and tear” arthritis are very limited, the options being:

1. do nothing
2. take painkillers
3. hip replacement surgery.

The only definitive treatment is option 3, which for most patients is a life changing procedure. Unfortunately it has a limited lifespan, and in general is only offered to more severely affected patients. As this condition can start in the 50’s or younger, we have the difficult task of informing people that they will have to put up with the pain for many years before surgery will be considered. The problem with evidence based medicine (EBM) is that it leaves lots of gaps, which CAM (complementary and alternative medicine) is more than happy to fill.

On a daily basis, we have to inform patients that their self limiting viral illness/gastroenteritis etc. will not respond to antibiotics. It is so easy to skip the explanation and just dish out the pills, but with the advent of MRSA and other drug resistant nasties, the finger is pointing more and more at “irresponsible GP’s” and their over-prescribing of antibiotics as the cause of this new epidemic. How tempting it would therefore be to prescribe a harmless placebo that might make people feel better, psychologically if not physically. There is however, something inherently dishonest about this approach that would prevent me and most of my colleagues from doing so.

However, a small – but noisy – bunch of GPs DO seem to have followed this route, and regularly post articles and comments in GP magazines. Here are a few quotes (s0urces available on request):

“I have studied homeopathy, scientifically, not in a non-touchy feely way, and have found it to be extremely helpful in areas of medicine where conventional alternatives have not helped. As a GP, I have found homeopathy on occasion to work exceptionally well, and if it does no harm, then why not try it?”

And:

“I couldn’t explain it then and I can’t explain it now. Those who dismiss homeopathy because it does not fit their world view do themselves a disservice, by not attempting to listen to homeopaths or read what they write, unless it is to seek out reasons to toss a few more metaphorical rocks.”

A particular vociferous voice is Andrew Sikorski, a Sussex-based GP and member of the executive council of the Faculty of Homeopaths. He regularly hounds Edzard Ernst and the blogs of Pulse magazine, quoting latin phrases in an impressively self-deluded manner. For example:

“The best EBM would be studying N=1 trials with the particular patient to see what suits their needs best and provides an optimum outcome. Rarely does my patient match the inclusion criteria of a single study, let alone amalgamated studies included in met-analyses. Yet I am heartened by the research which suggests there is an inbuilt healing system within us all and judiciously following Hippocrates’ dictat ‘primo (primum) non nocere’” – Source: Pulse 03/12/09

In other words, in his view, randomised blinded placebo controlled trials are of less value than individual anecdotal evidence. Hippocrates did indeed require that practitioners “first do no harm”, and in his day doing nothing was significantly less harmful than the black magic that was offered at the time. In fact Hippocrates dispelled a lot of the mysticism that dominated health care at the time, and I have no doubt that had he lived today, he would advocate modern evidence based medicine.

There is currently something of a battle going on at government level, fuelled by HRH’s “Foundation for Integrated Health”. Homeopathy has been part of the NHS for many years, with 5 Homeopathy hospitals nationwide, including one in Liverpool. These cost the NHS several million pounds a year to run, and are so established that it is hard to see how they will ever be closed down. The National Institute for Clinical Excellence uses the latest evidence to advocate EBM, and yet we are undermined by the government who are now proposing a “Personal health budget scheme” where patients can choose how NHS money is spent on them, including homeopathy, acupuncture and other alternative treatments. Indeed recent NICE guidelines (normally the bastion of EBM) for back pain are particularly worrying, as the working group included acupuncturists and chiropractors, but no pain management specialists. Not unsurprisingly the guidelines include these alternative therapies.

What’s the harm in CAM? Consider the death in 2000 of a 6 month old baby, whose parents refused conventional medicine in favour of alternative therapies. A leading homeopath was quoted by the BBC:

“Increasingly, with the rise in popularity of complementary medicine these situations are going to arise. Also there is considerable scepticism about some of the aspects of conventional medicine.”

I couldn’t have put it better myself.

As far as the cost is concerned, it was estimated in 2007 that the money spent on homeopathy by the NHS could have saved 600 lives by the prescribing of Herceptin to more breast cancer patients. (Source: Baum, M., et al)

The fact that Prince Charles meets the health secretary on a regular basis, and in the light of the same health secretary’s recent performance in the parliamentary select committee on homeopathy, it would suggest that CAM has more than just a foot in the door. In my view, the Merseyside Skeptics new 10.23 campaign could not have come at a better time. The more public awareness of what is being done in their name (and with their money) the better.

Dr. Selva Rasaiah
10:23

*Update: After feedback, a couple of the facts here have been happily amended to come more into line with current medical procedure*

I’m always fascinated by which ideas people hold as their metaphorical cow.  A few years ago, when I first started getting enthusiastic about skepticism, I was ranting in the pub with a doctor friend of mine about homeopathy, crystal healing, iridology, and their friends.  We laughed and joked together about the implausibility of it all and the lack of credible evidence, until I mentioned acupuncture.  Suddenly, his face fell and his tone became more stern. “Actually, acupuncture is effective and there are good scientific reasons for that.”

I was briefly taken aback by this.  My friend is one of the most fiercely scientifically-minded people I know, to the point where he has been accused of bringing down a fun, but daft, conversation by pointing out how daft it is from a scientific stand point.  He was the last person I would have expected to claim efficacy for a pseudomedical practice like acupuncture and looking back now, I should have asked him to explain.  Instead, the subject was dropped, glasses were refilled and conversation breezed on to something else.

As an aside, my doctor friend isn’t the first (and wasn’t the last) person I know to have made positive noises about the efficacy of acupuncture and I can’t help but think it seems to be a particular blind spot for people who are otherwise skeptical of pseudomedicine. Or maybe that’s just confirmation bias on my part.

Back to the plot.

A couple of weeks ago, the Archives of Internal Medicine published the results of a new study which suggested that acupuncture was effective for lower back pain.  In fact, it was so effective that you don’t even have to do any actual acupuncture for it to work; you can play pretend acupuncturist and get results that are just as good.  Steve Novella definitively took apart the conclusions of this study for Science-Based Medicine, and I shan’t attempt to repeat his arguments here. Go read it for yourself. Spoiler: what the data actually says is, acupuncture does not work.

On the heels of this study has come the news that the UK national health watchdog, NICE, have recommended that acupuncture should be made available to NHS patients suffering with lower-back pain.  Specifically, NICE suggest that patients who have suffered with non-specific lower-back pain for more than six weeks should be offered a twelve-week course of one of three “complimentary” therapies: acupuncture, chiropractic or exercise.

Why is this a problem?  Enumeration is always easier, since I don’t have to segue.

1. This is the first time that NICE has recommended such comprehensive use of pseudomedicine on the NHS; a worrying precedent.
2. The news comes on the very heels of the Archives study which, despite the conclusions drawn by the authors and reported in the press, very clearly shows that acupuncture is not effective for lower back pain.  You would almost think that the good people down at NICE had uncritically read the press coverage of the study, without actually reading the study itself.
3. Amusingly, alongside their recommendation to treat patients with placebo-needles and placebo-massage, NICE also recommend that other treatments are dropped to pay for it because… wait for it. Because they aren’t effective.  Oh, the irony!
4. Hold on, exercise? Since when was doing exercise considered a “complimentary” therapy?
5. This is a big PR-win for the pseudomedics, who are already being quoted in the press as saying “we always knew our therapies worked”.
6. If taken up, these recommendations will result in over £40m of tax payers money being paid to acupuncturists, chiropractors and osteopaths.