BHA Response Part 4: NICE evaluation and Homeopathy on the NHS

In the fourth of a linked series, the BHA provides detailed comments on the recommendations of the Science & Technology Committee’s “Evidence Check 2: Homeopathy” issued on 22 February 2010.

Part 4:   NICE evaluation and Homeopathy on the NHS
(Recommendations 18-24)

18. We accept that NICE has a large queue of drugs to evaluate and that it may have greater priorities than evaluating homeopathy. However, we cannot understand why the lack of an evidence base for homeopathy might prevent NICE evaluating it but not prevent the NHS spending money on it. This position is not logical. (Paragraph 90)

NICE usually reviews the use of specific interventions for particular conditions or groups of conditions, or issues guidelines making treatment recommendations for conditions or groups of conditions.  We are not aware that NICE has ever reviewed, for instance, antibiotics or a complementary therapy such as acupuncture, as a whole.  It is not clear why the Committee feels it should single out homeopathy in this way.  It would be more appropriate for NICE to make recommendations regarding the use of homeopathy – as it has, for instance, for acupuncture in the treatment of low back pain – in the context of condition-specific guidelines.  An obvious starting point would be the specific conditions that have been the subject of systematic reviews and meta-analyses of homeopathy.

Homeopathy on the NHS

19. When doctors prescribe placebos, they risk damaging the trust that exists between them and their patients. (Paragraph 97)

This point is entirely speculative and without any foundation in evidence.  Homeopathy has been in existence for 200 years and all available evidence suggests that patients generally have trust in homeopathic physicians, and that the doctor-patient relationship is excellent.  As previously noted, the evidence does not support the unequivocal view that homeopathy is a placebo.

20. For patient choice to be real choice, patients must be adequately informed to understand the implications of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done, the effectiveness of the placebo—that is, homeopathy—may be diminished. We argue that the provision of homeopathy on the NHS, in effect, diminishes, not increases, informed patient choice. (Paragraph 101)

The evidence does not support the view that homeopathy is a placebo.  It is perverse to claim that preventing patients from accessing homeopathy on the NHS in some way increases their choice.

21. We recommend that if personal health budgets proceed beyond the pilot stage the Government should not allow patients to buy non-evidence-based treatments such as homeopathy with public money. (Paragraph 104)

When allowed choice, significant numbers of patients opt for – often repeatedly – homeopathic treatment.  Successive governments have extended and reinforced patient choice, and rightly          so in our view.

22. When the NHS funds homeopathy, it endorses it. Since the NHS Constitution explicitly gives people the right to expect that decisions on the funding of drugs and treatments are made “following a proper consideration of the evidence”, patients may reasonably form the view that homeopathy is an evidence-based treatment. (Paragraph 109)

We again refer to the evidence from systematic reviews, meta-analyses and original clinical trials in specific conditions and from research in biological models.  This evidence, entirely ignored in the report, contains findings that do not support the view that homeopathy is a placebo.

23. The Government should stop allowing the funding of homeopathy on the NHS. (Paragraph 110)

See our response to Recommendation 24 below.

24. We conclude that placebos should not be routinely prescribed on the NHS. The funding of homeopathic hospitals—hospitals that specialise in the administration of placebos—should not continue, and NHS doctors should not refer patients to homeopaths. (Paragraph 111)

Considerable numbers of GPs and hospital consultants refer their patients to the NHS homeopathic hospitals because patients report benefit, an outcome also observed by their doctors.  Moreover, in the UK there are around 400 doctors – members of the Faculty of Homeopathy – who integrate homeopathic prescribing in their daily practice.  Homeopathy is safe, and evidence from the insured sector in the German and French healthcare systems shows that it increases cost-effectiveness in the management of common conditions.
Dr Sara Eames, President, Faculty of Homeopathy
Dr Peter Fisher, Director, Royal London Homeopathic Hospital
Dr Robert T Mathie, Research Development Adviser, British Homeopathic Association
Ms Cristal Sumner, Chief Executive, British Homeopathic Association