The random thoughts of a sceptical activist

1023

Another homeopathy fail

Prof Ernst has covered the details of the Judicial Review brought by homeopathy user Honor Watt against NHS Lothian after their decision to withdraw funding for homeopathy referrals to the Glasgow Homeopathic HospitalHomeopathy: another day in court + another defeat.

puffball

Puffballs

The judgement, published yesterday, names the three products she was prescribed and calls them ‘homeopathic medicines’: Agaricus and Rockrose for anxiety and Bovista for arthritis.

Ignoring the fact that many homeopaths would baulk at the notion of prescribing a homeopathic potion for a particular medical condition rather than treating her ‘holistically’, it’s interesting to look at these in a bit more detail.

We know that the Glasgow Homeopathic Hospital buys most or all of its supplies of homeopathy products from Freemans Homeopathic Pharmacy in the village of Busby, just south of Glasgow.

Agaricus and Bovista (puffball) are both genuses of mushroom and Freemans list four different Agaricus products: Agaricus Bulb, Agaricus Emet, Agaricus Muscarius and Agaricus Stercorarius, and one Bovista product: Bovista (Lycoperdon Gigan). It could well be these that Watt was prescribed.

Flower power

RockRose isn’t listed as a homeopathic product, but Rock Rose is one of the 38 Bach Flower products and Freemans do sell these — genuine Bach Centre products, apparently — so it could be this she was prescribed for her anxiety.

Homeopath Dr Edward Bach described Rock Rose thus:

The rescue remedy. The remedy of emergency for cases where there even appears no hope. In accident or sudden illness, or when the patient is very frightened or terrified or if the condition is serious enough to cause great fear to those around. If the patient is not conscious the lips may be moistened with the remedy.

Another one of the 38 Bach flower food products

Another one of the 38 Bach flower food products

Bach Flower products are not homeopathic, of course: they are very dilute herbal products, usually diluted to around 1 part in 100,000 using brandy and grape alcohol. And there is not a jot of good evidence to support any notion that it can do what Bach supposed it could.

But then, Bach Flower Remedies are foods, not medicines and have been that way since the medicines regulator, the MHRA, cancelled the Product Licences of Right (which they had held for the past 40-odd years) in January 2014. Because of this, they are now classified as foods and have to abide by the rules laid down by the EU Register of authorised health and nutrition claims. In the UK, advertising claims for food supplements fall within the remit of the Advertising Standards Authority. The rules do allow some health claims to be made, but only ones authorised as shown in the register. However, because Bach products are mostly alcohol, the rules rightly prohibit any health claims.

The Bach Centre sells Rock Rose in the usual 10 ml bottle for £5.99 to the general public. I wonder how much NHS Lothian were paying?

Only by the label

Of course, the two mushroom products are unlicensed medicines and as such, should not be advertised, sold or supplied to the general public, but we know that Freemans have sold other unlicensed medicines to the public, including homeopathic owl.

We also know that, once in their bottles, it’s a bit difficult to tell which is which. Giving evidence to the House of Lords Science and Technology Committee in 2007, Kate Chatfield. representing the Society of Homeopaths and a senior lecturer in homeopathy at the University of Central Lancashire was asked:

Lord Broers: I have a simple, technical question about homeopathy and drugs. Is it possible to distinguish between homeopathic drugs after they have been diluted? Is there any means of distinguishing one from the other?

Ms Chatfield: Only by the label.

Prof Ernst was also present, but Hansard doesn’t record whether he chuckled at that admission.

Too many Cooks?

John Cook of North West Friends of Homeopathy and director of the British Homeopathic Association (BHA) gets a mention in the judgement as having been specially invited by Lothian Health Board during their consultation and the judgement mentions that the Board’s submission says:

The real force behind the petition [to the Court of Session] was a charity, not the petitioner. [Honor Watt]

The Judge says no more about this — presumably because it was irrelevant to the case as presented — but the BHA is mentioned in relation to its position on the evidence for homeopathy.

We know the BHA — and John Cook in particular — are staunch defenders of homeopathy and they are one of only of several homeopathy charities, but it does seem a fair assumption that it was the BHA that was behind this — they are a charity, after all. Perhaps they were funding it as well. It could have been another homeopathy charity, Homeopathy: Medicine for the 21st Century [sic]. Who knows? If you do, please let me know.

I was checking the documents of the BHA that are filed at Companies House and noticed that two documents were filed on 20 August:

Termination of appointment of John Kenneth Halesworth Cook as a director on 15 April 2015
Termination of appointment of Francis Samuel Treuherz as a director on 3 August 2015

The BHA’s website still shows Treuherz (who also runs the website Homeopathy Helpline [sic]) as a trustee, but not Cook. Cook is shown as a Trustee in archive.org’s cache of that page on 16 March 2015.

The Charity Commission also shows the Treuherz as a trustee, but not Cook but their 2013–2014 report (filed on 15 May 2015) states (bizarrely):

Mr John K H Cook (retired 15 April 2015)

Interestingly, their area of operation as noted on the Charities Commission website is ‘Throughout England and Wales’. If it really was them behind the JR in Scotland, might the Charities Commission be interested (although given recent events it seems unlikely)?

It could be Cook was due to stand down (he was 68 in April) anyway… but is it a coincidence these documents were filed just seven days before the judgement was handed down?

CCG_BSC-2015

CCG Homeopathy Funding Status – 2015

Marginalised

Whatever has been going on, the fact remains that homeopathy on the NHS is becoming increasingly marginalised, adding to the other recent signs that homeopathy is in its death throes on the NHS:

The (further) decline of homeopathy on the NHS

NHS Lanarkshire to end referrals to Glasgow Homeopathic Hospital

More misleading claims at NHS Homeopathic Hospitals

NHS Homeopathy Legal Challenge

NHS Homeopathy Spending

And what better excuse is needed to again highlight this, showing the decline in the number of NHS homeopathy prescriptions fulfilled in community pharmacies in England: a drop of 94% in the past 17 years.

The decline of homeopathy in the NHS (number of prescription items)

The evidence for David Tredinnick MP

Last month, the following exchange took place in the House of Commons during Health Questions, supposedly about the Government’s revised adult Autism strategy:

David Tredinnick (Bosworth) (Con): Is my right hon. Friend aware that there is clear evidence that homeopathy is effective in treating autism, especially when doctors have not found a solution? Now that the Society of Homeopaths is regulated by the Professional Standards Authority, will he make more use of homeopathy in the health service generally, and in this particular instance?

Mr Speaker: The hon. Gentleman’s question is quite a long way from the statutory guidance, but it can be given a brief reply.

Norman Lamb: I have to say that I was not aware of the information provided by the hon. Gentleman. I should be happy for him to send me more information, but I make the general point that it is always important for us to base our decisions and expenditure on evidence.

We know Tredinnick is a True Believer in homeopathy and all thing quackish, but here is a definitive claim that “there is clear evidence that homeopathy is effective in treating autism”.

There is, of course, no good evidence homeopathy can effectively treat any condition whatsoever other than HWS (Heavy Wallet Syndrome), but it would certainly be interesting to see what evidence Tredinnick thought substantiated such a bold claim.

Since Normal Lamb (Minister of State for Care and Support at the Department of Health) asked Tredinnick to send him that information, I submitted a Freedom of Information Act request to the DoH to get hold of that ‘clear evidence’.

Response

The information provided consisted of a letter from Tredinnick, an article from the magazine Homeopathy in practice from 2010 titled Saving a lost generation: Autism and homeopathy and a screenshot of the home page of the website CEASE Therapy, originally created by the late homeopath and MD Tinus Smits:

 

See also Lee Turnpenny’s take on this FOIA response: ‘MINISTER FOR QUACKERY’: TREDINNICK’S CONTINUING FOLLY

The letter

Tredinnick told Lamb:

As you will be aware, in the past 20 years there has been a dramatic rise in neurological and developmental disorders in children, particularly Autism Spectrum Disorder (ASD). Conventional medicine considers ASD incurable, and offers powerful pharmaceutical medication to deal with the most difficult behaviour, often with serious side effects.

However, there is ongoing work in this area by homeopaths in various places around the world including the Netherlands, United States and Australia, which suggests that homeopathy could be effective in tackling the possible underlying causes behind autism. I attach an article and information on this for your information.

Whilst the evidence on autism could be described as anecdotal, there were, up to the end of 2013, a total of 188 RCT papers in homeopathy (on 100 different medical conditions) which have been published in good quality scientific journals. 44% of the RCTs have a balance of positive evidence and only 5% are negative. The remainder were inconclusive which does not mean they are negative.

In light of the large number of conditions that conventional medicine finds difficult to treat, including autism, this is an area which does warrant further research.

zombieWhere to start with this…

Tredinnick regurgitates the same old zombie arguments and fallacious nonsense homeopaths and their supporters are wont to do.

But remember Tredinnick proclaimed in the House that “there is clear evidence that homeopathy is effective in treating autism”, so it’s surprising that he didn’t bother to provide any…

But at least he now says:

Whilst the evidence on autism could be described as anecdotal…

Is this his ‘clear evidence’? Is he now saying that anecdotal evidence is ‘clear evidence’ or has he realised that anecdotes are not ‘clear evidence’ and shifted his position? I doubt he has any clue.

Imaginary numbers

He has clearly taken what the British Homeopathic Association have published as gospel, but he’s quoted what they said last year:

BHA evidence page in 2014Click to enlarge

The Homeopathic Interpretation

How homeopaths like to present the evidence

The BHA’s current page has slightly different numbers, but let’s take Tredinnick’s outdated numbers to show how he misrepresents the balance of evidence.

He states that only 5% are negative and that 44% are positive. But what of the remaining 51%? Tredinnick tells us these are ‘inconclusive’ and implies that these should just be ignored.

But that’s not how it works.

Prof Edzard Ernst deals with this very problem in his blog post: The alchemists of alternative medicine – part 3: the ‘NON-CONCLUSIVE’ method:

A clinical trial is a research tool for testing hypotheses; strictly speaking, it tests the ‘null-hypothesis’: “the experimental treatment generates the same outcomes as the treatment of the control group”. If the trial shows no difference between the outcomes of the two groups, the null-hypothesis is confirmed. In this case, we commonly speak of a negative result. If the experimental treatment was better than the control treatment, the null-hypothesis is rejected, and we commonly speak of a positive result. In other words, clinical trials can only generate positive or negative results, because the null-hypothesis must either be confirmed or rejected – there are no grey tones between the black of a negative and the white of a positive study.

Homeopaths don’t like the way this turns out: it would mean that there were more negative trials than positive and that wouldn’t look too good in their advertising. It’s bad for business.

So, how could they spin this to make it look good for homeopathy?

Prof Ernst nails it:

One fairly obvious way of achieving this aim is to simply re-categorise the results. What, if we invented a new category? What, if we called some of the negative studies by a different name? What about NON-CONCLUSIVE?

How exactly do we do this? We continue to call positive studies POSITIVE; we then call studies where the experimental treatment generated worst results than the control treatment (usually a placebo) NEGATIVE; and finally we call those studies where the experimental treatment created outcomes which were not different from placebo NON-CONCLUSIVE.

The Null Hypothesis Interpretation

What the evidence says in reality

Genius! (And it’s not often that can be said about homeopaths!)

The trick that Tredinnick uses makes it look as if the balance of evidence for homeopathy is overwhelmingly in its favour (44% to 5%), but the correct way to state his numbers is: 44% are positive and 56% are negative. Remember Tredinnick said “The remainder were inconclusive which does not mean they are negative”, but oh yes, it does mean they are negative — they do not refute the null hypotheses: they are therefore negative.

But even then it’s still not that simple.

All trials are equal, but some are more equal than others

There is no doubt that some of these 44% trials will be of a higher quality than others and what’s important is which of them are the better ones and what do the results of those show. Creating a trial that gives positive results for homeopathy is easy, but we should not be swayed by any trial without looking closely at how robust it is. If it is a trial that was not robust methodologically, we should view it with suspicion and treat its results with extreme caution. What we need to do — assuming what we’re trying to achieve is not to confirm preconceived beliefs but to genuinely look to see what the best, most robust, most independent, least biased evidence tell us — is to tentatively acknowledge those better results until such time as even better evidence comes along.

This isn’t the place to go through all the trials making up the 44%, but it’s useful to remind ourselves of the time when the Society of Homeopaths were investigated by the Advertising Standards Authority over claims they made. Their evidence was demolished by the ASA as not being up to the standard required to substantiate the claims they made. Although the ASA don’t identify the evidence the SoH provided, Cool Hard Logic on YouTube has had a very good go at identifying most of the papers. His demolition of them is a joy to watch. Click here to watch the video

But as Linde et al. noted after examining 89 placebo-controlled trials of homeopathy:

We conclude that in the study set investigated, there was clear evidence that studies with better methodological quality tended to yield less positive results.

Of course, looking at all the best evidence leads to just one conclusion:

It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.

That’ll be a negative, then.

Why does Tredinnick believe otherwise?

The magazine article

Next up is the magazine article Tredinnick sent to Lamb. Perhaps it has that elusive evidence?

It’s not really worth demolishing all the tropes spewed out in it by homeopath Carol Boyce MCH CCH RSHom(NA), but the flavour of it can be got from just a couple of quotes:

Under the guise of ‘protecting’ children from the ‘scourge’ of childhood diseases, known to kill or maim just a handful of (already sick) children every year in the West, the push for enforced mass vaccination may be trading our children’s entire futures and with them the very future of society itself. (For more information on this see: http://www.ageofautism.com.)

The link to the notorious anti-vax site Age of Autism is very telling.

But, of course, homeopathy comes to the rescue:

Treating a case of ASD [Autism Spectrum Disorder] should be no different for the homeopath than any other case, although the options for success seem to be increased when the homeopath is familiar with the specific symptomatology of ASD, in order to identify the strange, rare, peculiar and characteristic symptoms of the case and not confuse them with those that belong to the diagnosis.

We can initially take the pressure off the system by removing the maintaining causes — gluten and casein — from the diet and supplementation to address the nutritional deficiencies that impact the ability to synthesise, catabolise and excrete.

Ultimately, though, the body must be able to complete these processes independently in order to sustain health in the absence of supplementation. Once these metabolic processes are reset and working efficiently, it stands to reason that external supplementation is no longer required and has the potential to overload the system, especially a system that has already had problems with excretion and subsequent toxicity.

There you have it in all it’s sciencey-sounding jargon finery, the simple solution to treating ASD.

If only someone would tell the doctors.

At least the article doesn’t fall into the usual referenciness trope and lists just:

REFERENCES

Baron-Cohen S et al (2009) ‘Prevalence of autism-spectrum conditions: UK school-based population study.’ The British Journal of Psychiatry 194, 500-509 http://www.cdc.gov/vaccinesafety/Activities/vsd/priority_studies.html#3

Knapp M, Romeo R, Beecham J (2007) Economic Consequences of Autism in the UK. Foundation for People with Learning Disabilities

Boyce C (2007) ‘Magnus Pharma and the Golden Goose — The case of allopathy and the implications for homeopathy.’ Similia Vol 19 No 1 June 2007

Klein L (2010) http://www.narayana-verlag.com/spectrum-homeopathy/louis-klein-the-orchid-project?fromOverview=spectrum-homeopathy-012010

Scholren J (2009) http://www.interhomeopathy.org/lanthanides_in_pdd_nos

Shang A (2005) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67177-2/abstract

None of those, however, provide Tredinnick’s ‘clear evidence that homeopathy is effective in treating autism’.

Just stop it

And finally, CEASE Therapy.

Standing for Complete Elimination of Autistic Spectrum Expression, this has also been well covered elsewhere: here by Orac:

Apparently Tinus Smits was no different. I’ll give him credit, though. If you’re a homeopath and believe that autism is caused by vaccines, toxic medicine, other toxic substances and “some diseases,” what would you treat autistic children with? If you know the Law of Similars, you know the answer. The Law of Similars states that the way to treat a symptom is to use a diluted substance that causes the symptoms. So, if you’re a homeopath, it’s rather obvious. If you believe, against all science, against all reason, against all medicine that vaccines, “toxic medicine” and other “toxic substances” cause autism, then there’s only one thing to do, isn’t there. Yes, that’s right:

The treatment of autistic children and even adults has matured through 300 cases over the last three years and is called CEASE Therapy, which stands for Complete Elimination of Autistic Spectrum Expression. Step by step all causative factors (vaccines, regular medication, environmental toxic exposures, effects of illness, etc.) are detoxified with the homeopathically prepared, that is diluted and potentized substances that caused the autism. Currently we use the 30C, 200C, 1M and 10M potencies to clear out the energetic field of the patient from the imprint of toxic substances or diseases.

Yep. Unadulterated pseudo scientific nonsense.

CEASE Therapy is frequently advertised on the websites of homeopaths and the notion that vaccines are the cause of just about everything is well ingrained in the homeopathic psyche.

But still no ‘clear evidence’. Perhaps there isn’t any after all.

Healing

Coincidentally, Tredinnick is hosting an event at Westminster this evening that promises to be, erm, interesting. As announced on the website of the Confederation of Healing Organisations:

CHO Tredinnick event

An email sent out by a PR company (whose website doesn’t even appear to work) gave more details:

The evening, co-hosted by David Tredinnick and the Parliamentary Group for Integrated Healthcare, will begin with Professor Chris A. Roe (University of Northampton) presenting the positive results arising from the most comprehensive meta-analysis to date into the scientific evidence for the efficacy of healing as a complementary therapy. Immediately following this there will be a unique opportunity to question several of the lead researchers about the research and also the results. There will then be a wider discussion with the researches [sic] and a variety of representatives within the healing community about the implications of these results and what this means for healing as a complementary therapy within and alongside the NHS.

Forget homeopathy. Move aside chiropractic. Ignore acupuncture. We appear to have good positive evidence for Healing!

But what is ‘Healing’? Even the Complementary and Natural Healthcare Council, which ‘regulates’ Healers, isn’t very clear on what it actually is, saying simply:

The history of Healing stretches back for thousands of years. Nowadays most Healers view their work as a natural and purposeful energy based process which, from mostly anecdotal evidence, is believed to help relieve everyday stress, provide a sense of physical and emotional revitalisation and on some occasions bring about a deep sense of peace.

If you’re none the wiser, you’re not alone.

Anyway, this new evidence is being presented by Chris Roe, professor of psychology at the University of Northampton. His list of current research projects includes:

To conduct an analytical review of the published empirical studies on healing to date to determine whether it is tenable to claim that directed intention can have a measurable effect on another living system and to identify best practice to maximise effect sizes in future research (Confederation of Healing Organisations)​

…so it looks like he’s presenting the results of this research.

It’ll be interesting to see what this meta-analysis is and how it stands up to scrutiny. Will it be ‘clear evidence’ as Tredinnick might think, or just ‘homeopathic’ levels of evidence?

If I get any information on it, I’ll let you know.

Oh my God — it’s full of stars!

While we’re talking about Tredinnick, the Good Thinking Society is still waiting to hear from him after they asked him to help them test astrology.

Tredinnick certainly seems to believe in it. In the House of Commons in 2009, he declared:

In 2001 I raised in the House the influence of the moon, on the basis of the evidence then that at certain phases of the moon there are more accidents. Surgeons will not operate because blood clotting is not effective and the police have to put more people on the street.

It would be easy, you would have thought, to provide evidence for clear claims such as those.

Evidence, for David Tredinnick, is nebulous, variable and malleable to suit whatever hobby-horse he is currently promoting.

How on earth did he get on both the Health and Science and Technology Select Committees if he is so clueless about evidence?

Capricorn

David Tredinnick is a Capricorn, of course.

An idiot’s guide to understanding NHS homeopathy prescription data

A guide for the clueless

When writing Nightingale Collaboration newsletters, I presume readers have some basic science, search, maths and critical thinking skills. I’m sure this covers a good proportion of readers, but there seem to be some who are somewhat more challenged in these areas.

Some homeopathy supporters seem particularly inept when it comes to verifying evidence, data, facts and generally looking stuff up. Proper research seems well beyond their abilities.

In the newsletter The decline of homeopathy on the NHS, I gave links to the original Government sources for the data I used. This is certainly more than sufficient for any reasonably capable reader to use to verify the figures and charts I had created, but not, it seems for some.

So, to show how I arrived at the charts that shows the decline of homeopathy on the NHS, this is an appropriately named idiot’s guide to accessing and extracting the data from the original Government source and checking the charts.

Here’s one of the charts that some homeopathy supporters didn’t seem to like.

The decline of homeopathy in the NHS (number of prescription items)

Figure 1: The decline of homeopathy in the NHS (number of prescription items)

I can understand why homeopaths might not like it, but letting their beliefs get in the way of reality is their problem.

One particular homeopathy supporter apparently believed that searching the HSCIC website using the words I used in the title of the chart and getting no results was sufficient ‘research’ to proclaim triumphantly:

Tweet - redacted to protect the guilty

Tweet – redacted to protect the guilty

(Click on the image to see a larger HSCIC search page screenshot.)

That would appear to be the limit of her ‘research’ abilities.

Curiosity is what makes a scientist: not being satisfied with not knowing, not understanding; being inquisitive; not giving up at the first hurdle; pushing on and on…

Homeopaths on the other hand seem content with anything that confirms their  beliefs — particularly if it saves them having to think for themselves.

Data extraction and analysis

So, for those unable to do see how to do it for themselves, here’s where the data come from and how they were extracted to form the charts.

As I said in the newsletter, there are two websites for the data: the HSCIC website for data since 2004 and the National Archives for older data. The HSCIC is the Health and Social Care Information Centre, the Government body that collects these data — and much more besides — and is the official source for all NHS data.

The data I used are the Prescription Cost Analysis (PCA) data. This gives data on all English NHS prescriptions fulfilled in community pharmacies. The HSCIC website search for these data returns links to pages for each year. This is published in April of each year, so the latest is the data for 2013.

Let’s take the data for 2013 as an example, but this applies to all years.

Clicking on the page for that year gives Prescription Cost Analysis, England – 2013.

The source data are listed at the bottom under the heading Resources. The one of interest here is the zip file that contains all the original data rather than the other files, which are just summaries, etc. So, in this case, the file required is Prescription Cost Analysis, England – 2013: Tables [.zip]. This file is 2.3 MB.

This is a zip file, but most computers should be able to open it. In the zip file is an Excel spreadsheet, pres-cost-anal-eng-2013-tab.xls. This file is over 7 MB. Opening this in Excel gives a work book with seven tabs. The lowest level source data is the tab called ‘Individual Preparations’. This spreadsheet has over 23,000 rows and 17 columns of data, giving nearly 400,000 cells of data.

Some familiarity with Excel has to be assumed here. If anyone doesn’t know what Excel is, doesn’t have it or can’t competently use it, then that’s not my problem. If your computer can’t handle large spreadsheets, that’s your problem too.

These data are identified by the type of prescription according to the classes in the British National Formulary (BNF). Prescriptions for homeopathy products are categorised under the single class of Chapter 2, Section 3, Paragraph 3, Sub Paragraph 0, ie BNF 19.2.3.0.

We only need one row: the one for homeopathic prescriptions. In this file, it is row 12,331. It can also be found by searching for ‘homeopathy’: this is worth doing anyway to check there are no other rows for homeopathy. This row has the correct BNF class as given above. The BNF SUB PARAGRAPH NAME is ‘Homeopathic Preparations’.

The columns of interest are the ones headed ‘Items (thousands)’ and ‘NIC £ (thousands)’. ‘Items’ is the number of prescription items and NIC is the Net Ingredient Cost, the basic cost per item, before discounts and does not include any dispensing costs or fees. These terms are defined in the Glossary.

From the 2013 data for Homeopathic Preparations, the figures are:

  • Items (thousands): 13.001
  • NIC £ (thousands): 137.298

This is 13,001 prescription items at a total cost of £137,298.

These figures can be checked by looking at the tab called ‘Totals for BNF Sub Paragraphs’. This totals all the data by BNF sub paragraphs and row 336 confirms the above figures and that we have not missed any data in the ‘Individual Preparations’ tab.

The charts I created use these data and the data obtained in exactly the same manner for the other years. Collating the data for each year from 1995 to 2013 from the respective spreadsheets and putting them into a table gives:

Year

Prescription Items

Net Ingredient Cost

Cost/item

1995

164,207

£816,798

£4.97

1996

172,013

£914,983

£5.32

1997

162,421

£937,311

£5.77

1998

157,063

£927,633

£5.91

1999

147,769

£888,274

£6.01

2000

134,164

£831,130

£6.19

2001

127,333

£807,125

£6.34

2002

117,989

£778,749

£6.60

2003

103,940

£714,938

£6.88

2004

94,501

£661,469

£7.00

2005

82,960

£593,316

£7.15

2006

62,679

£442,769

£7.06

2007

49,316

£321,418

£6.52

2008

26,337

£152,300

£5.78

2009

19,005

£100,486

£5.29

2010

16,359

£121,449

£7.42

2011

15,501

£130,601

£8.43

2012

15,262

£143,068

£9.37

2013

13,001

£137,298

£10.56

 

Charting these data gives the charts here and in the newsletter.

The decline of homeopathy on the NHS (prescription costs)

Figure 2: The decline of homeopathy on the NHS (prescription costs)

The third chart, the average cost per prescription item, is simply the total cost per annum divided by the number of prescription items and can be checked with a calculator.

The rising cost of homeopathy in the NHS (average cost per prescription item)

Figure 3: The rising cost of homeopathy in the NHS (average cost per prescription item)

For anyone who’s interested, the above is more than sufficient to check each chart back to the original, authoritative source data to ensure the charts are accurate.

These data clearly demonstrate to all but the most clueless that homeopathy on the NHS has declined drastically over the last 18 years. For those less numerate, the pictures show this even more clearly.

The skills required are basic: there’s no multi-variant analysis, no calculation of a p-value, no calculating the skew or kurtosis of a distribution. It’s all very simple and straightforward data extraction, basic computer literacy, Excel skills and simple arithmetic.

It is all basic stuff; something that scientists and skeptics do all the time to check their facts, figures and data, but, it seems, something that homeopaths and homeopathy supporters are incapable of.

Falling trust in homeopathy

There’s an un-written rule — or at least there should be — that anything said in support of homeopathy cited by a homeopath or supporter should be taken with a large pinch of natrium muriaticum.

That’s not to say homeopaths will always be wrong or there won’t be some grain of truth in what they say, of course, but it will always bear a bit of investigation. There will frequently be more to it than meets the eye.

Take for example, a homeopath citing the meta-analysis Clinical trials of homoeopathy by Kleijnen et al. (1991). Nancy Malik summarises this paper thus:

Clinical Trials of Homeopathy (1991) FULL TEXT // 81 (77%) out of 105 RCT (1943-1990) shows statistically significant result for homeopathy and 15 out of 22 best quality studies are also statistically significant.

Out of 81, 5 out of 5 of the clinical trials for hay fever showed a positive result and 8 out of 10 trials looking at mental or emotional problems showed a beneficial effect, while 6 out of 7 trials for infection showed that homeopathy could effectively relieve the problem.

“Based on this evidence we would be ready to accept that homoeopathy can be efficacious, if only the mechanism of action were more plausible” and “the evidence presented in this review would probably be sufficient for establishing homoeopathy as a regular treatment for certain indications……..a conventional method would have been acknowledged with this amount of evidence”, the results are mostly favourable for homeopathy regarding the quality of trials.”

Glowing praise for homeopathy it would seem, but what she fails to mention is the conclusion the authors reached, quoted here in full:

Conclusions At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials.

Homeopathy pelletsSpot the difference. Malik does try to link to the paper (but not to an accessible copy of it), but how many will click on her link to check the veracity of what she says? Some other examples of conclusions homeopaths would rather you didn’t read can be found on the Discover Homeopathy website.

Anyway, the point is made: always check original sources to make sure claims made by homeopaths for homeopathy are complete and accurate.

Trustworthy

How much do people trust homeopathy? That’s difficult to know unless a survey is done asking that specific question. We could perhaps use the sales of homeopathic products as a proxy, but market surveys are complex things to do and tend to cost a lot on money. Mintel, for example, will sell you their market survey on homeopathic and herbal products in the US for a mere £2,466.89 (Excl.Tax), or their report Complementary Medicines – UK – December 2009 for just £1,750. Well beyond the reach of many, including me.

But the teaser for that last report does tell us:

Growth in the UK’s £213 million complementary medicines market [note: not specifically homeopathy] has gathered pace in the last two years. It is estimated to have grown in value by some 18% between 2007 and 2009 when Mintel last reviewed the industry.

We also know that the market for homeopathic and anthroposophic medicinal products in the EU exceeded €1 billion for third year in a row in 2011. It doesn’t tell us anything about the sales in the UK, but it’s still an interesting figure. Whither the cries of homeopaths that they have no money for decent trials? And we know there is plenty of scope to raise the money for trials if they really, really wanted to.

But homeopaths frequently like to use increasing sales figures in the mistaken belief that this somehow correlates with efficacy. Equally, sales figures are not a measure of trust: they tell only about the success of marketing and PR that they do about whether homeopathy works or whether people trust it.

But fortunately, there are some limited data available that answers that question about trust.

Twittering

In a recent Tweet, a dedicated homeopathy supporter claimed:

60% growth h’pathy mkt in Europe 1995-2005 Mintel est sales in UK to reach 46M pds 2012

When asked for a source of those figures, she replied:

Mintel, Global Global TGI Barometer — look them up

I did.

As I said, Mintel reports cost a lot of money, but I thought it would be interesting to see if I could find the Global TGI Barometer source.

A search shows that the one Global TGI (Target Group Index) Barometer that pops up regularly on homeopaths’ websites is the Global TGI Barometer, January 2008, Issue 33: The lure of alternative medicine. It’s this article that is cited frequently in support of homeopathy, eg:

British Homeopathic Association: The growing demand for homeopathy

A survey conducted by Global TGI in 2008 found 15% of the population of Britain trusted homeopathy.

Homeopathy manufacturer, Nelsons: 150 Facts About Homeopathy

57.  In India, alternative treatments, including homeopathy, are well established and integrated into the healthcare system, with 94 per cent of people saying that they have faith in alternative remedies.[8] [8]  Global TGI Barometer, January 2008; Issue 33.

Dr Brian Kaplan: Homeopathy in perspective:

Homeopathy has never been so popular; currently 15% of the population of Britain trust it.1 Homeopathy is the fastest-growing form of complementary medicine and has experienced a growth of 44% since 2004.1 1. Global TGI Barometer, January 2008; Issue 33.

Homeopath, Paula Yates:

It is estimated that between 6 and 9 million people in the UK choose to use homeopathy (Source: Global TGI Barometer, issue 33 – Jan 2008).

Homeopath, Gill Marshall:

It is used by 15% of people in the UK, 27% of Germans and 40% of French people. (2)

(2) Global TGI Barometer January 2008 Issue 33: The lure of alternative medicine.

There are a couple of websites that seem to give most of the text of the article (eg here and here, but the links to the original source are broken), but none looked like the full article, so I asked the publishers, Kantar Media. Although the document is some six years old, they were kind enough to send me the full, original article: The lure of alternative medicine.

This was about a survey of 13 countries, finding out what proportion of people agree with the statement ‘I trust homeopathic medicine’: I trust homeopathic medicine This puts a rather dramatic perspective on the 15% figure for Great Britain.

Additionally, it’s clear that many of the statements made by homeopaths about this article are not supported by what the article actually says! I have to wonder if any of them actually read the article — it is only three-and-a-half pages long — or whether they were just parroting what others had said.

The article also says:

In many countries, particularly in Europe, consumers are less convinced. At 15% agreement, Britons are the least trusting of homeopathy, and only 1 in 10 say that they prefer alternative medicine. Even in Germany, the birth place of homeopathy, just 27% of people trust this kind of treatment. France is the European market in which people are most trusting of homeopathy.

Unfortunately, we can only speculate about the historical, cultural and political reasons for these marked differences, but maybe the reason for the figure for France is more obvious?

But now we know that one of the sources the homeopathy supporter cited did not substantiate the claims she made for the growth in homeopathy. No surprise there. Copying and pasting without engaging brain is an all too familiar gambit of homeopathy supporters — perhaps through ignorance or in the desperate hope that no one will bother to check… More likely, though, it can be attributed to a complete lack of curiosity on their part.

In decline

We already know that homeopathy in the NHS has been in steep decline for the last few decades: The decline of homeopathy on the NHS This could well indicate that homeopathy isn’t as unthinkingly accepted as it once was.

But the Global TGI Barometer data was from some six years ago — what about trust in homeopathy now? Although Kantar Media haven’t publicly published such a comprehensive survey since 2008, in 2013 they published a Factiod, a single page document Headache Remedies: East vs. West. In it, they were able to say:

TGI data shows that 43% of people in China agree with the statement ‘I trust homeopathic medicine’ compared to just 20% in the USA and 12% in GB.

It would have been good to see up-to-date figures for the other countries, but this does show that trust in homeopathy products in Great Britain has dropped by a fifth,  from 15% in 2008 to just 12% in 2013.

As more people find out what homeopathy is and how homeopathy works, we should not be surprised to see this figure drop even more.

Paying the price of homeopathic research

Do homeopaths’ claims that trials are too expensive and that they can’t afford them hold water?

Science is simply a systematic way for carefully and thoroughly observing nature and using consistent logic to evaluate results. Which part of that exactly do you disagree with?

— Dr Steven Novella

Homeopaths have an ambivalent attitude to research: they are quick to jump on any results they think support their pseudo scientific beliefs, yet any paper that shows homeopathy to be no better than placebo is denounced, usually with cries that the ‘homeopathic system of personalised, holistic medicine’ is just not suited to being tested using flawed ‘conventional’ double-blind randomised controlled trials (DBRCT). And sometimes Big Pharma tell lies.

But homeopaths have a problem: all advertising in the UK has to comply with the Advertising Standards Authority’s CAP Code and this rightly demands a high standard of evidence for any claim, regardless of whether it’s about how clean a soap powder makes your whites, how efficient double-glazed windows are or how much a skin cream reduces the appearance of wrinkles. So it is with homeopathy: high quality evidence is required. Continue reading

Stop this unscientific meddling

The exposé  by Prof David Colquhoun of the interference by the Department of Health — at the behest of homeopathy promoters — in the publication of impartial, scientifically-based information about homeopathy on the NHS Choices website has been covered by the Guardian and the Daily Mail this past week.

Damned by their own words, the DoH said in response to the draft submitted by the editors of NHS Choices that mentioned the House of Commons Science and Technology Committee’s comprehensive Evidence Check report on homeopathy:

Can we remove this statement? This report is really quite contentious and we may well be subject to quite a lot of challenge from the Homeopathic community if published.

The statement was removed. What NHS Choices were eventually told to publish was a biased sop to homeopathy, including a list of the main homeopathy trade bodies and a list of medical conditions homeopathy could, apparently, treat.

Andy Lewis, on his excellent website, The Quackometer, asked that we contact our MP over this to demand NHS Choices be allowed to replace this biased page with one that properly reflects the scientific consensus on homeopathy so that the public can make properly informed choices in their health care.

Below is our email to our MP. We urge all those concerned about the public being given unbiased information to write to your own MP — please feel free to use whatever you feel useful.

We are concerned to read that the Department of Health has been interfering with the content of the NHS Choices website to the detriment of the public’s ability to make informed choices about health care.

It was reported in the Guardian on 13 February (Prince’s charity lobbied government to water down homeopathy criticism) and in the Daily Mail on 15 February (Homeopathy charity run by Charles ‘cowed civil servants’ into supporting the therapy) that the NHS Choices website editor had been prevented from stating the lack of scientific evidence for homeopathy for fear of lobbying from the ‘homeopathy community’. This debacle came to light after a Freedom of Information request by Professor David Colquhoun.

As a result of this interference, the page on homeopathy as it stands now is in danger of misleading the public into thinking that homeopathy may be able to treat potentially serious medical conditions such as asthma, ear infections, high blood pressure and depression when there is no scientific evidence to suggest this is the case.

In his response to the House of Commons Science and Technology Committee’s Evidence Check report on homeopathy (which recommended removal of all NHS funding for homeopathy because of the complete lack of scientific evidence), the Secretary of State for Health stated:

10. In order for the public to make informed choices, it is therefore vitally important that the scientific evidence base for homeopathy is clearly explained and available. He will therefore engage further with the Department of Health to ensure communication to the public is addressed. His position remains that the evidence of efficacy and the scientific basis of homeopathy is highly questionable.

He also stated:

14. The Government agrees that, when looking at the evidence base for efficacy, it is important to focus on the most scientifically robust studies and evidence.

It is therefore incomprehensible and deplorable that the Department of Health believes it now acceptable to tell the public that homeopathy can be used to treat the following:

  • asthma
  • depression
  • ear infections
  • hay fever
  • other mental health conditions, such as stress and anxiety
  • allergies, such as food allergies
  • dermatitis (an allergic skin condition)
  • arthritis
  • high blood pressure

For such a highly respected, informative and authoritative source of sound medical information such as NHS Choices to have been forced by the DoH into publishing such erroneous information on homeopathy is disgraceful and unacceptable.

This can only lead to the public being mislead and potentially making ill-advised and dangerous health care decisions.

As we are sure you are aware, the Chief Medical Officer, Professor Dame Sally Davies, has recently made clear that homeopathy is ‘rubbish’. The DoH needs to heed this advice and allow NHS Choices to completely re-write the page on sound scientific and evidence-based principles.

We also note that Anna Soubry recently stated to the House:

The Department [of Health] does not maintain a position on any particular complementary or alternative medicine treatments including homeopathy.

We therefore ask you to request that the Secretary of State for Health explain these actions and that he allow NHS Choices the freedom to ensure that the public can make the informed choice that are entitled to make based on sound scientific evidence and principles and not to have that distorted by vested interests.

We look forward to receiving your reply.

Thanks and best regards.

I’ll let you know what response we get.

The bitter sugar pill

In his Guardian article, Homeopaths offer to rebrand products as ‘confectionery’, Martin Robbins tells the story that, faced with being unable to sell their products as homeopathic medicines because they were unlicensed, a manufacturer offered to re-brand them as sweets. The irony of that won’t be lost on many, but what else has been going on?

…sceptics [are] posing as genuine members of the public…

Thanks to his FOIA request, we now know that the medicines regulator, the MHRA, told homeopathy manufacturers Helios and Ainsworths to discontinue the sale and supply of a number of their kits of homeopathic products because they contained homeopathic products that were not registered (under the HR scheme) or authorised (under the NR scheme) and because the names of the kits were not as had been registered with the MHRA.

McCarthy-style reporting, encouraged by the self-appointed detractors of homoeopathy…has protracted this decline [in the homeopathy industry]

These two issues are important: under the Medicines Regulations, individual homeopathic products have to be registered or authorised by the MHRA, and so do kits of these products, with the name of the kits agreed with the MHRA.

Helios and Ainsworths fell foul of the Medicines Regulations on both counts.

Continue reading

That ‘neutral’ Swiss homeopathy report

What does the Swiss Government really think about homeopathy?

By Sven Rudloff and Zeno

Jump to Postscript

A lot has been made by homeopaths about the ‘neutral’ Swiss Government’s report and its unequivocal support of homeopathy. It’s been lauded by the luminaries of the homeopathic world as further proof — as if any was needed, of course — that homeopathic ‘medicines’ are superior in every way to those dangerous and expensive pharmaceutical drugs.

Arch proponent of homeopathy, Dana Ullman, proclaimed:

The Swiss government’s exceedingly positive report on homeopathic medicine

The Swiss government has a long and widely-respected history of neutrality, and therefore, reports from this government on controversial subjects need to be taken more seriously than other reports from countries that are more strongly influenced by present economic and political constituencies.

In late 2011, the Swiss government’s report on homeopathic medicine represents the most comprehensive evaluation of homeopathic medicine ever written by a government and was just published in book form in English (Bornhoft and Matthiessen, 2011). This breakthrough report affirmed that homeopathic treatment is both effective and cost-effective and that homeopathic treatment should be reimbursed by Switzerland’s national health insurance program.

The provisional reimbursement for these alternative treatments ended in 2005, but as a result of this new study, the Swiss government’s health insurance program once again began to reimburse for homeopathy and select alternative treatments. (Source, cached)

Ullman again:

this report from the Swiss government has confirmed the efficacy and cost-effectiveness of homeopathic treatment. (Source, cached)

The Society of Homeopaths:

Swiss scientists endorse homeopathy evidence

Report says homeopathic medicine is clinically effective

A comprehensive and authoritative research study by Swiss scientists has offered an unambiguous endorsement of the evidence base for homeopathy as a clinically effective system of medicine.

Their report, part of a Swiss government evaluation of complementary and alternative medicines, gives a massive boost to the growing body of research underpinning the therapeutic effects of homeopathic medicine. (Source, cached)

The Faculty of Homeopathy and the British Homeopathic Association:

Evidence for homeopathy builds

Long-awaited English translation of Swiss study endorses evidence for homeopathy

This important report addresses the evidence for the effectiveness of homeopathic therapy in everyday use (i.e. the real world), its safety and its cost-effectiveness.

The authors, Doctor Gudrun Bornhöft and Professor Peter Matthiessen, state: “There is sufficient evidence for the preclinical effectiveness and the clinical efficacy of homeopathy and for its safety and economy compared with conventional treatment.”

Following on from the initial publication of this report, a public referendum in Switzerland in 2009 supported the inclusion of homeopathy and other complementary and alternative medicines in the Swiss national health insurance, with 67% of the people voting in favour. Earlier this month, the Swiss government passed legislation to enact the referendum’s conclusion. (Source, cached and source, cached)

GP and homeopath Dr Andrew Sikorski:

In 2009 a Swiss national referendum voted in favour of complementary medicine being part of the public health service which is now covered by the obligatory public health insurance system. This decision was partly informed by the findings of the 2006 Health Technology Assessment report commissioned by the Swiss Government on the effectiveness, safety and cost-effectiveness of homeopathy in general practice. (Sourcecached)

Many other websites have echoed these sentiments, with many taking their lead from Ullman’s article and possibly placing far too much reliance on what he had to say, eg Swiss Government finds homeopathy effective and cost efficient (cached).

You’d think from all this that the ‘neutral’ Swiss Government had taken to homeopathy like the proverbial quacking duck to water.

Of course, to state in this context that the Swiss Government has a ‘widely-respected history of neutrality’ is to conflate political neutrality with scientific objectivity.

As usual, research of truly homeopathic proportions, misrepresentation and cherry picking are the order of the day.

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Changing times for homeopaths

Many websites of homeopaths are changing. Some as a direct result of being contacted by the Advertising Standards Authority (ASA) and some, no doubt, because, now they are aware of the ASA’s rules, want to be responsible and abide by them.

I’ve been watching several websites change over recent months: some delete a few words here and there; some have had to make substantial changes; and some have yet to make the necessary changes.

One of the websites I’ve been watching is the one belonging to the Society of Homeopaths.

Their home page had this:

Homeopathy is an evidence-based medicine which offers holistic, individual and integrated treatment with highly diluted substances with the aim of triggering the body’s natural system of healing.

A few days ago, they changed it to say:

Homeopathy is a form of holistic medicine in which treatment is tailored to the individual.

Have they finally realised that it’s not ‘an evidence-based medicine’; that there is no robust scientific evidence (ie the kind required by the ASA to protect the public from misleading claims) that homeopathic sugar pills have any effect over placebo?

I doubt it, but sooner or later homeopaths have to realise that they have to abide by the same rules as every other advertiser: if you make a claim, you must have robust evidence to substantiate it.

If a double-glazing seller claims his windows use an alternative glass that works far better than ‘conventional’ glass, then we would — rightly — expect him to be able to back up that with good evidence. There cannot be one standard for, say, double-glazing sellers and different, lower standard, for homeopaths.

And so with the homeopaths or any other advertiser of alternative therapies. Indeed, there could be a case made for requiring an even higher standard of evidence for claims about healthcare made to an unsuspecting public.

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Dangerous homeopathy

It’s bad enough when homeopaths take good money from people, claiming they can cure their colds or clear up their eczema with sugar pills. It’s another thing entirely to claim to prevent or treat serious diseases with identical sugar pills.

But this is precisely what the BBC’s Newsnight programme discovered homeopaths were doing. Broadcast in January, Pallab Ghosh exposed the disgraceful behaviour of a north London homeopath and a homeopathic ‘pharmacy’ selling sugar pills as a malaria preventative.

Watch the whole sorry exposure, even if you’ve watched it before:

As Dr Simon Singh said on the programme:

Choice is fine as long as it’s based on accurate information. And the information that’s being given out by pharmacists, by celebrities endorsing homeopathy, by the NHS offering homeopathy — the implication here that homeopathy must be effective otherwise people wouldn’t sell it, profit from it or offer it in the high street. And I am utterly shocked that we have a woman here [Zofia Dymitr, Chairwoman of the Society of Homeopaths] saying that she’s not going to forbid her members from offering homeopathic prevention of malaria to the general public. There are people coming back from tropical countries with multiple organ failure having used homeopathy and yet this woman is not prepared to stop it.

I was here four years ago when Newsnight did your last investigation and BBC Scotland have done an investigation and BBC South West have done an investigation. The BBC are the only people regulating homeopathy at the moment, because the Society itself seems to be oblivious to its responsibility.

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