Should homeopathy be included on the NHS? Most of us would say no, simply because we do not believe the evidence supports the basis on which homeopathy is claimed to work. “Like cures like” is possible enough – indeed, it sounds very similar to the basis on which working vaccines to diseases like flu are created. But the process of diluting – succussing – homeopathic remedies that progressively removes more and more of the original active substance from the sugar pill/water/alcohol substrate clearly is at odds with everything we know about how chemistry works.
Through the miracle of the Internet, I spent part of this afternoon sitting at my desk watching live video from the House of Commons Science and Technology Sub-Committee as they debated the question above. The detail of the witnesses: Rt Hon Mike O’Brien QC MP, Minister of State, and Professor David Harper CBE, Chief Scientist, Department of Health, and Professor Kent Woods, Chief Executive, Medicines and Healthcare Products Regulatory Agency.
The main justification for including homeopathy appears to be its popularity: 10 percent of the population use these remedies. (By this logic, smoking should be included on the NHS!)
One of the committee members asked about the disparity in the rules, in that homeopaths don’t have to prove the efficacy of their remedies, but the manufacturers of vitamin supplements do.
Some other interesting questions were raised. Is it acceptable for a doctor who knows that a homeopathic remedy has no effect other than the placebo effect to dispense these remedies to patients on the basis that they might work. Should he be required to disclose to the patient his knowledge that they are no better than placebos? Most patients would probably resent this kind of “paternalistic deception”.
Besides, the minister said later, it’s “illiberal” to refuse people treatments they believe are working. He drew a distinction between efficacy (evidentially proven) and effectiveness (helps patients). Some numbers: 88 PCTs do not provide homeopathy, 26 do in exceptional cases; 31 do. (I think those hastily scribbled numbers are right.) NICE does not consider the evidence base sufficient to assess these remedies.
There seems to have been some (now sadly typical) trouble over the consultation on the subject of introducing rules for homeopathy, in that although it was opposed by several eminent medical bodies the recommendation that eventually reached the minister was that there was widespread support. Professor Campbell replied that the debate is about homeopathy, but there were few objections to the scheme itself. The committee asked him to make the consultation testimony public. “This is a homeopathic medicinal product used within the homeopathic tradition” is the wording on the label; what does this mean to the “average man in the street”? Doesn’t it imply the stuff, you know, works? (I’m paraphrasing; the questioner managed the most polite version of “Isn’t this a lie to the public?” that I’ve ever heard.)
I can’t answer that personally, but I can recount the argument I had recently with an American friend. It went like this:
“The Royal Family uses homeopathy and look how long they live!”
“The Royal Family is one of the richest families in the world, and besides homeopathy they use all the best medical care their money can buy.”
“They do?”
Homeopathy isn’t harmful in and of itself. Its wider effects – a lack of care for evidence and the truth, diverting people from medicine that works (it has been recommended as an anti-malarial drug), and the promotion of general ignorance – are harmful.
(Ben Goldacre also featured in a previous session, of which a webcast can be seen here.)
