Evidence-based policy – MPs call for an end to homeopathy on the NHS

It isn’t often that Members of Parliament are praised, vilified as they are over their expenses, point-scoring and deference to vested interests. Yet this week has seen a moment of real clarity in Westminster, a true demonstration of how our elected leaders can exercise critical thinking and formulate policy based on objective, rational evidence – and all this over some tiny sugar pills.

Monday saw the publication of Evidence Check: Homeopathy, a report by the House of Commons Science and Technology committee (full report available as a PDF here). This report followed months of taking evidence from various parties – from registered homeopaths and representatives of retailers that sell such ‘remedies,’ to medic and journalist Ben Goldacre and Professor of Complementary Medicine Edzard Ernst. Analysing this evidence were Committee Chairman Phil Willis MP and Dr. Evan Harris MP, as well as several Labour and Conservative Members. Their findings generated quite some media interest, with dozens of stories leading with the Committee’s call to withdraw NHS funding for homeopathy on the grounds that it is ‘implausbile’ (for more in-depth coverage of the report and its implications, please read the quackometer bloggimpy’s blog, the Stuff and Nonsense blog and Martin Robbins’ piece in the Guardian) Let’s look behind those headlines to the work the Committee did, and why I for one want these MPs (or most of them) to be praised from the rooftops.

Homoeopathy –  a system of medical thought devised by Samuel Hahnemann at the turn of the 19th Century and based on the principle that like-cures-like and that ultra-dilute doses* make stronger remedies – has been available on the NHS since its inception; indeed there are four NHS homeopathic hospitals (another was shut down last year), and it is estimated that up to £10m of taxpayers’ money is spent annually on this form of alternative medicine. Which would not be of concern, were it not for the fact that there is not a jot of reliable evidence to suggest that homeopathic remedies work beyond the placebo effect. (*as I pointed out in a recent blog post, remedies are often diluted to ‘1-in-1,000,000,000,000,000,000,000,000,000,000,000,000,000,000, 000,000,000,000,000,000 molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.’)

This is where the Committee’s work began, and from the very beginning they took an approach rarely seen in politics and governance – they first assessed what current government policy regarding homeopathy was, then discussed the evidence base for that policy, and finally made recommendations based on said evidence. Consider, evaluate, act, as some blog or another is called…

They report that whilst the ‘Department of Health (DH) … “does not maintain a position”  on any complementary or alternative treatment, including homeopathy … Primary Care Trusts (PCTs)are responsible for commissioning care services and are thus currently free to fund homeopathy.’ This official neutrality is presumably there to encourage what has become the raison d’être of the modern NHS – patient choice. So the government’s stance was to offer homeopathy for free as a matter of choice – but the committee asked what its predecessors had not, which was simply this: can, and does, homeopathy work?  This then was the ‘evaluate’ section of the report, and by far the most important.

To differentiate between evidence from homoeopathists (who, perhaps unsurprisingly, claimed that there was indeed evidence that their remedies worked) and other more sceptical witnesses who claimed the opposite, the committee decided to include only evidence from well-conducted, blinded, randomised clinical trials – the gold standard in evidence-based medicine, where there is every possibility that any treatment effect of a drug is down to its own action and not to placebo. This is the first point that I want to emphasise – that instead of treating all evidence as equal, instead of putting poor-quality anecdotal ‘evidence’ (repeat after me: the plural of anecdote is not data…) on a par with well-controlled peer-reviewed studies, the Committee insisted that NHS policy should be based on the most reliable evidence available. For this they are to be congratulated – it isn’t enough to equivocate when faced with a hierarchy of quality, no matter how much homeopaths themselves bleat that their precious case studies (I had a headache, I took a pill, it went away…) have been ignored.

So on the basis of the best evidence available, the Committee concluded that, on the question of scientific plausibility (can homeopathy work?), the answer was a resounding no – in their own words, ‘we consider the notion that ultra-dilutions can maintain an imprint of substances previously dissolved in them to be scientifically implausible.’

So what, many homeopathists say – our patients report that after taking our pills they felt better; isn’t that what matters? So we come to the question of efficacy (does homeopathy work?). Again, using the best available evidence, the Committee concludes that ‘In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos.’ The Committee noted that those in favour of homeopathy regularly cherry-picked individual studies that supported their position, and ignored the vast body of quality research that refuted their position. Again, a point worth emphasising – it isn’t enough to say that ‘I believe X works for Y,’ you have to produce high-quality evidence to back up your claim – and not just reports of what is essentially a regression fallacy.

Lastly the Committee looked at the issue of product labelling – the MHRA, the regulatory body charged with overseeing the licensing of medicinal products, came in for some heavy criticism here. Essentially, the MHRA has a rigorous regime that drugs must pass through in order to be approved for use – a regime that includes regulated clinical trials, a solid basis for efficacy, and an excellent safety profile. We can be sure that homeopathic sugar pills satisfy the latter, it’s the former two criteria that they would fail on – only as it stands, the MHRA licences homeopathic pills without any consideration of their efficacy, just their safety. Such a two-tier approach, with one rule for genuine medicines and another for placebo-based diluted nothing, was deemed to be inappropriate.

In summing up, the report states that, considering the evidence, if NHS doctors prescribe homeopathic medicines, ‘they risk damaging the trust that exists between them and their patients.’ Moreover, the Committee concludes that ‘when the NHS funds homeopathy, it endorses it,’ and therefore ‘The Government should stop allowing the funding of homeopathy on the NHS.’

Of course this damming verdict matters, and of course the MPs have made the right judgement in calling for an end to government-sponsored homeopathy. But as a scientist trained in the evaluation of evidence, whose profession rests on rigorous and critical analysis of evidence regardless of one’s prior assumptions, the process through which they reached their conclusions matter more. It is great to see rational scientific principles being brought to bear in the formulation of policy. Now all that remains is for the government to accept the Committee’s findings, and for the rest of governmental policy to be subjected to such thorough evidence checks. Well, one can but hope!

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42 Comments

  • Except for Bob Russell MP, who has signed this EDM: http://tinyurl.com/yzmsrps. I am rather embarrassed that a parliamentary member of our party has signed up to such anti-science piffle.

  • Anthony Aloysius St 24th Feb '10 - 3:06pm

    Quite right. I’ve never been able to understand why (as far as I know) it isn’t party policy to abolish NHS support for homeopathy.

  • I feel rather strongly about this, so I’ve created a Facebook group calling on Bob Russell MP to withdraw his support for the EDM: http://www.facebook.com/group.php?v=info&gid=320696079951

  • Simon Titley 24th Feb '10 - 5:02pm

    Two pieces of satire have effectively skewered ‘alternative therapies’…

    Mitchell & Webb’s homeopathic A&E:
    http://www.youtube.com/watch?v=HMGIbOGu8q0

    The Daily Mash:
    http://bit.ly/9lB15N

    If homeopathy works, then so should the Daily Mash’s suggestion: “The report could see government funding into the not-treatment being stripped back to £1 as according to homeopathic theory it will have the same effect as giving them £100 million. Practitioners will apply for one penny of the new budget and then be advised to shake it vigorously in their bank account.”

  • I haven’t believed in it since the age of eight when during a boring evening left on my own at home I munched my way through my parents’ stock of homoeopathic pills with no discernable effect. However, it does occur to me to wonder whether it is a cost-effective treatment for the many people who believe in it. After all, the placebo effect is demonstrably extremely powerful, and probably particularly so if it is supported by a pseudo-scientific infrastructure. Without reading the Committee’s report I don’t know if they considered this point, but despite the treatment being completely unscientific it could still be creating value for money for the NHS, in which case why stop funding it?

  • I hate to interrupt a good bit of alternative therapy bashing, but if a placebo works and is safe and cheap, why on earth should we stop funding it?

    I haven’t had a chance to read the report but I disagree with Prateek’s assertion that the key issue is isolating the effect of the homeopathy compared to a placebo. Surely the fair test should be whether it actually has a beneficial effect, regardless of what is causing this.

    One example: should we stop funding arthroscopic surgery for osteoarthritis of the knee because it doesn’t work?

    http://content.nejm.org/cgi/content/full/347/2/81

    Arguably yes, because it doesn’t work – it is just the placebo effect. But if people can walk and have vastly improved mobility as a result of the procedure, then who are we to say they shouldn’t? This is the reason that around 650,000 of these procedures are still carried out in the US at over $5,000 a pop (I imagine they are also carried out in the UK but don’t have info on this). Compared to this the 10 million cost of homeopathy seems a small price to pay for patient choice and improved health.

    I normally have the greatest of respect for Even and Phil, but I’m not sure this is either liberal or a sensible use of campaigning resources.

  • Sorry James, I think that response is a bit simplistic. For a placebo to work successfully the patient has to believe it is going to work. Millions of people believe in homoeopathy: if they believe that it has any scientific basis then they are wrong, but if, for whatever reasons, they believe that it is going to do them some good then it well might. “Magic feathers” might work for a few simple-minded people but they are not all that likely to be effective for very many. And is there any evidence to suggest that there are very many rich ‘sugar pill salesmen’? How about rich drugs salesmen? Rich cosmetic surgeons? I don’t think this is a productive line of argument: perhaps someone could address the points made above by Joel and myself instead.

  • In the 19th Century and before, doctors education was largely on manners and so on. I imagine that most success was down to placebo at these times. There is no reason why we can’t have evidence based policy: use the drugs, and train doctors to give out medicine in the most placebo-maxing way. That would use the most of the evidence we have (though we should stick to truthfull comments, which reduces it a fair bit, for ethics sake…)

  • I’m sure that inducing a placebo effect is legitimate practice in many cases and should be an option open to GPs, but that still doesn’t justify spending NHS money on homeopathy. If placebo is the only consideration then surely bog-standard sugar pills will work just as well as very expensive magical sugar pills that have had spells cast on them by a witch-doctor, but at a fraction of the price.

  • I’m sure that March 2007 is too long ago to judge people for having expressed misguided views, even if they are MPs. We can rebuke them for not having been careful but if they really have seen through the woo now then I wouldn’t hold it against them.

    I am pleased to see that Walley is not a signatory to either EDM & that we are having some respect for science & rationality, especially since Simon Singh seems to to have had a good day.

  • Asquith may be right about the 2007 EDM but I am concerned to see that Mike Hancock has now joined Bob Russell in signing the current one. http://edmi.parliament.uk/EDMi/EDMDetails.aspx?EDMID=40517&SESSION=903

  • Thank you Prateek Buch for engaging with the argument I was putting forward. I probably didn’t make my central point clearly enough last night because I wasn’t feeling too well, but I took some Nux Vomica and….only joking! I don’t believe there is any scientific basis to homoeopathy and I don’t believe it works for me, but essentially what I was wondering was whether the committee had done a cost/benefit analysis (if such a procedure is still used) on the existing homoeopathic institutions operating under the aegis of the NHS. If they are not providing value for money then withdraw public funding and let them fund themselves in future – it seems that private homoeopathic practitioners can successfully make good livings; but if, as I suspect, they have financial outcomes that are as good as, or better, than similar mainstream institutions in the NHS then withdrawing funding would be tantamount to an abuse of power by the scientific rationalists. And just in passing, I don’t think a 6.7% net profit on turnover amounts to getting rich!

  • Anthony Aloysius St 25th Feb '10 - 9:33pm

    “… if, as I suspect, they have financial outcomes that are as good as, or better, than similar mainstream institutions in the NHS then withdrawing funding would be tantamount to an abuse of power by the scientific rationalists.”

    If a “cost/benefit” analysis indicates that treatment based on a placebo has a better “financial outcome” than one based on a scientifically proven drug, then I’d suggest there’s probably something wrong with the analysis!

    Not that I find it difficult to believe that it would. After all, sugar is pretty cheap!

  • As a former scientist, I can say for the first time in my life a politician impressed me. I watched the debates online and can say Evan Harris is the kind of man I want for my MP; very professional in his dealings. I’m pleased, really pleased at the report. However, I’m saddened by the reaction of too many MPs.

    Too many MPs seem to reject scientific evidence; something I find bizarre for a country where the sciences are promoted as being essential to the UK economy.

    Can MPs really continue to ask the public to pay for an education, an education and expertise they seem to undervalue so readily by dismissing the report?

    How many votes will this group of MPs risk losing, not only of the science graduates themselves but of their friends and family as a result? Is it fear of upsetting a scientifically illiterate group of voters? Should I ask how scientifically literate are our MPs in general? Could a group of MPs be so afraid of science that a refresher course in the basics would do them, the public, and journalists a great deal of good?

    Are they simply afraid to challenge scientifically illiterate journalists in the press and cheap magazines who may try to create a fuss in order to steal headlines? Why can’t our politicians stand on top of a mountain and proclaim the wonder of science and take great pride in the efforts of scientists and the committee for shining a light on wasteful use of money within the NHS, and have a press event while they hand over the rescued cost to university researchers seeking to find effective treatments for any number of afflictions?

    Do I want MPs who show so little regard for evidence to sit in a jury let alone make decisions regarding the running of this country, preferring instead to court incompetent journalists rather skilfully deal tabloid headlines the contempt they so obviously deserve? I do genuinely ask myself that question. There would be outrage if a conviction failed due to a jury disregarding solid scientific evidence on the basis of not wanting to upset a particular group of society, wouldn’t there?

    MPs can not have it both ways. Do they value evidence in their decision making, decisions that can and do affect our laws and freedoms, the health of the UK population, our standing as a world force in science and many, many other arenas, our security and even decisions that may send our armed forces to war?

    These days, we come with both a vote and an education, something MPs would do well to remember as they fight for the political lives. The politicians of the UK must understand that they must demonstrate their ability to be professional, fair and just to the electorate. We need smart and strong politicians to lead us into the coming years and MPs must demonstrate that they have the necessary ingredients to lead us into a future where we will rely more heavily on science and technology.

    Is it wise to face up to the evidence now, educate politicians and the public where necessary and stop funding the supply of treatments that are no more than water or sugar pills on the NHS up and down the length of the UK. After all, it has been 300 years or thereabouts since the Enlightenment. In future years, we may well find ourselves facing more challenging technological and scientific questions and out politicians are required to demonstrate they are capable of making sound decisions from now on, particularly after the recent political scandals. We need an informed group of people to represent us, people who will agree with the electorate when our views are similar, but equally have the spine to stand up and fight for right over wrong, even if a proportion of the electorate do not like what they hear.

    Can out politicians demonstrate to the electorate that they understand and will do what is required to govern effectively and honestly?

    This small country gave us so many scientific greats including Joseph Black (carbon dioxide), James Watt (steam engine), Alexander Fleming (penicillin), Robert Watson-Watt (radar), Joseph Lister (antiseptic surgery), James Clerk Maxwell (thermodynamics and electromagnetic theorist), Watson & Crick (DNA), the recent Nobel Laureates Paul Nurse, John Sulston and Tim Hunt among so many other scientific giants. Surely the politicians of this small country can demonstrate a concise scientific understanding that illuminates the best British science has and can offer just as deftly as Evan Harris.

  • Mary – Indeed. But scientific literacy is not enough -my MP was a chemist (Des Turner) but he seems completely useless, a member of the committee, but (I skimed the report) didn’t seem to turn up, doesn’t debate. He is leaving at this election, and seems to have thought he now has no responsibilities (not that he did anything anyway}.

  • Mary – Indeed. But scientific literacy is not enough -my MP was a chemist (Des Turner) but he seems completely useless, a member of the committee, but (I skimed the report) didn’t seem to turn up, doesn’t debate. He is leaving at this election, and seems to have thought he now has no responsibilities (not that he did anything anyway}.

    (In other words, Evan Harris is something special!)

  • Anthony Aloysius St 28th Feb '10 - 9:45am

    I was quite appalled to see that the party had produced an official reaction to the report, saying that it fundamentally disagreed, and that NHS spending on homeopathy should continue – though apparently the document was “rescinded” a few hours later:
    http://www.theliberati.net/quaequamblog/2010/02/27/what-the-lib-dem-policy-on-homeopathy-is-not/

    Indeed, the party actually seemed to be advocating increasing NHS spending on homeopathy (and other “alternative medicine”) by having GPs prescribe these quack remedies:
    “the measured introduction of treatment with CAMs therapies at primary care level has the potential to reduce expensive secondary referrals and/or long term expensive drug therapy in a range of conditions”

    That kind of thing makes the party sound almost as loopy as the Green Party on this issue.

  • Malcolm Todd 28th Feb '10 - 10:56am

    I suspect that having scientifically literate journalists and editors would make more difference than doing the same with MPs.

  • Prateek Buch
    Thank you! I might just do that.

    Your right about how tempting it would be to stuff Parliament with PhDs; though I doubt many would want to.
    I’d prefer to see plumbers sitting beside the chemists, a hotel receptionist sitting beside the lawyer, a whole range of people with all sorts of backgrounds. So long as they are honest to me and to themselves and work hard for the salary, a salary which most people can only dream of, while taking responsibility for themselves when representing the people who voted for them, then that is fine.

    I’d really like to see your suggestions of ‘Making policy makers more democratically accountable and having select committee have more power to hold government to account would help more‘.

    I want my MP, any MP sitting on a select committee to have enough gumption to admit he is out of his depth on a particular subject, then get up off his backside and either find out or excuse himself honestly. I’ve no idea about the rest of the world, but if my new MP, and it will be a new MP, wants my respect and a repeat vote, then he is going to have to be honest. Why so many MPs find it so easy to disregard such an excellent committee is beyond me. Why bother having them!!

  • Malcolm –
    That is the crux of the issue. When you have not only the Mail, Telepgraph and such like, but also the Guardian providing the cliche’s of our time (scientists need to be more humble, etc) you know that there is going to be a long struggle.

    I think it is that journalists want to contribute something to the discussion, but find that they can easily be ignored by the detailed, evidence-based arguments of scientists and academics in general; they want to kick back, and do what they do best: use ad hominems and irrlevence.

    It is a shame. I saw recently that the Economist wants a new science correspondent, and explicitly stated that they would prefer someone with a background in science who can write, than a journalist with an interest in science. To be applauded: but perhaps there arn’t enough of the latter covering Westminster, where it counts?

  • Congratulations, you have skewered my chance of persuading my girlfriend in Bristol South to vote Lib Dem instead of Labour, precisely because you have come out against homeopathy. I always thought that Liberals were less concerned about being ideologically sound than Labour or the Tories but obviously I was wrong.

  • These two links are essential watching for anyone who has an interest in homeopathy. I wouldn’t regard science as an ideology since it is a method used to understand how the world works. Science has shown homeopathy doesn’t work, as the Boots man himself made clear. My understanding is the LibDems argue that medicines that have good evidence to support their effectiveness should be available on the NHS while treatments we know from evidence not to work shouldn’t.

    HoC Science and Technology Sub-Committee

    HoC Science and Technology Sub-Committee 2

    Perhaps showing these videos to your girlfriend may help you convince her the LibDems are worth reconsidering.

  • Hmm, it seems from the comments here that Cleggy’s Militant Tendency exists. Who would have believed it? What next, outlawing religious belief because the existence of God cannot be proved to Richard Dawkins’ satisfaction? It seems that if you don’t fully sign up to a materialist philosophy and the interests of the pharmaceutical industry you aren’t welcome in some Lib Dem circles. And just at the point when the Lib Dems are breaking through. To Mary, who decided to attempt to convert my g/f from a lifelong belief in homeopathy with two TV clips, you might just find your irresistable force running up against the immoveable object of her belief. And you still will have lost her vote. There’s nothing more resistable politically than evangelicals attempting to homogenise the world around them.

  • Anthony Aloysius St 19th Apr '10 - 4:35pm

    Con

    You seem to have misunderstood. No one is talking about “outlawing” homeopathy, if people want to spend their own money on it.

    What people object to is pouring millions of pounds of public money down the drain on such quackery, when the NHS is so short of money and treatments with proven curative effects are having to be rationed.

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