Saturday, 4 August 2012

The (lack of) evidence for Homeopathy

Yesterday, I mentioned the House of Commons Select Committee (Science and Technology Committee) Evidence Check 2: Homeopathy.

It's quite a long report, so I think it worth highlighting a few of the conclusions here:
54. We conclude that the principle of like-cures-like is theoretically weak. It fails to provide a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science.

61. We consider the notion that ultra-dilutions can maintain an imprint of substances previously dissolved in them to be scientifically implausible.

70. In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos. The Government shares our interpretation of the evidence. We asked the Minister, Mike O'Brien, whether the Government had any credible evidence that homeopathy works beyond the placebo effect and he responded: "the straight answer is no".

77. There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities.

82. We do not doubt that homeopathy makes some patients feel better. However, patient satisfaction can occur through a placebo effect alone and therefore does not prove the efficacy of homeopathic interventions.

101. We agree with Professor Ernst and the RPSGB. 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.

109. 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.

Conclusions

110. The Government's position on homeopathy is confused. On the one hand, it accepts that homeopathy is a placebo treatment. This is an evidence-based view. On the other hand, it funds homeopathy on the NHS without taking a view on the ethics of providing placebo treatments. We argue that this undermines the relationship between NHS doctors and their patients, reduces real patient choice and puts patients' health at risk. The Government should stop allowing the funding of homeopathy on the NHS.

111. 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.
I'm not sure whether the NHS still funds it but I am sure that it shouldn't. It appears, however, that BUPA are no do know is that BUPA no longer do, at least for its "bupa Select" cover. Point six on their notification for change states:
6. Complementary medicine practitioners, homeopathy
 We no longer provide cover for homeopathic treatment.
Homeopathy: there's nothing in it.

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