The random thoughts of a sceptical activist

Government

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.

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.

Fog on the Tyne

The Freedom of Information Act 2000 (FOIA) is an important tool for everyone, not just skeptics. It gives the right to anyone to ask for any information held by public authorities who are obliged to supply that information unless it is covered by a limited number of exemptions.

The House of Commons Justice Committee said earlier this year:

The Freedom of Information Act has been a significant enhancement of our democracy.

Indeed it is, but it is under threat and a campaign was started earlier this year to protect it. The threats to it are concisely summarised in an e-petition to the Government (unfortunately now closed):

Leave FOI Alone (#saveFOI)

Responsible department: Ministry of Justice

The Freedom of Information Act 2000 (FOI) has exposed the scandal of MPs’ expenses, and many examples of waste and improper behaviour by public authorities, politicians and public officials. We call on the government not to allow it to be watered down, nor for there to be a charge for making requests for information.

The public authorities covered by the FOIA are listed in Schedule 1 to the Act and include the bodies you would expect and maybe a few you’ve never heard of.

But Trading Standards (TS) is one such public authority covered by the FOIA.

Each Local Authority in the country has a Trading Standards service and they are the guardians of an impressive list [Link disabled because of possible malware on that website] of regulations, orders and rules including the Consumer Protection from Unfair Trading Regulations 2008 and, of course, the Cancer Act 1939.

I have never requested any information under the FOIA about Trading Standards, but it’s easy to see that some information could be very useful in finding out, say, information on complaints and understanding how they work and deal with complaints.

A very useful tool for all Local Authority residents and others.

But maybe not in North Tyneside.

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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.

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The business of regulation

Simon Perry has been having an interesting email conversation with Maggy Wallace, Executive Chair of the Complementary and Natural Healthcare Council.

There have been a few emails back and forth — and it would be best to read the conversation before continuing — but I felt I needed to add my tuppence-worth:

 

Hi Maggy

I’ve been following your conversation with Simon Perry with interest and I’d like to respond to some of the points you made.

You said:

As a regulator you cannot honestly expect us to support a position as stated by you to the effect that ‘………..Genuine, honest training on reflexology must cover the simple truth that reflexology is not known to be effective for any condition.’

This is your opinion and in our view, is unsupportable as a statement.

Simon didn’t express an opinion and it’s entirely supportable. The scientific evidence on reflexology is clear: it is a nice foot massage, which some may find relaxing and stress-relieving, but nothing more. Any claims outside of that are not supported by the evidence.

You may not like the scientific evidence of course, but it is reinforced by the sheer implausibility of the claimed method of diagnosis and claimed mechanism of action for reflexology.

If you don’t agree with the scientific evidence, what do you base your assessment of reflexology on? What the professional associations tell you? Reflexology trade bodies? Your members’ websites?

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Humpty Dumpty regulation

The phrase Humpty Dumpty chiropractic cropped up in a Google Alert a few days ago. It was the fitting title of an editorial (cached) in the December 2010 issue of Clinical Chiropractic, which discussed the slippery and nebulous meaning of vertebral subluxation complex (VSC).

For those who don’t remember their childhood, in Lewis Carroll’s Through the Looking Glass, Humpty Dumpty is discussing the meaning of words with Alice. HD remonstrates:

‘When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

Such equivocation is typical of on-line conversations with chiropractic supporters discussing the VSC, but it applies elsewhere as well.

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The Mass Libel Reform Blog – Fight for Free Speech!

This week is the first anniversary of the report Free Speech is Not for Sale, which highlighted the oppressive nature of English libel law. In short, the law is extremely hostile to writers, while being unreasonably friendly towards powerful corporations and individuals who want to silence critics.

The English libel law is particularly dangerous for bloggers, who are generally not backed by publishers, and who can end up being sued in London regardless of where the blog was posted. The internet allows bloggers to reach a global audience, but it also allows the High Court in London to have a global reach.

You can read more about the peculiar and grossly unfair nature of English libel law at the website of the Libel Reform Campaign. You will see that the campaign is not calling for the removal of libel law, but for a libel law that is fair and which would allow writers a reasonable opportunity to express their opinion and then defend it.

The good news is that the British Government has made a commitment to draft a bill that will reform libel, but it is essential that bloggers and their readers send a strong signal to politicians so that they follow through on this promise. You can do this by joining me and over 50,000 others who have signed the libel reform petition.

Remember, you can sign the petition whatever your nationality and wherever you live. Indeed, signatories from overseas remind British politicians that the English libel law is out of step with the rest of the free world.

If you have already signed the petition, then please encourage friends, family and colleagues to sign up. Moreover, if you have your own blog, you can join hundreds of other bloggers by posting this blog on your own site. There is a real chance that bloggers could help change the most censorious libel law in the democratic world.

We must speak out to defend free speech. Please sign the petition for libel reform.

Mass Lobby for Libel Reform

Do you know who your MP is?

If you don’t, you can find him or her on the excellent They Work for You website.

Why is this important? Well, in case you’ve been hibernating all winter (and who could blame you), there’s going to be a General Election fairly soon and there’s no better time to lobby your MP and find out what his/her views are on important issues.

In case you’re struggling to think of something to ask your MP, here’s a suggestion:

Libel law.

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What a week for quackery!

Phew! This has been a spectacular week or so for alternative medicine.

Firstly, we had the Landmark ASA ruling on asthma and colic. Then we have the spectacle of some of its major proponents being tortured and exposed before the House of Commons Science and Technology Sub-committee looking into the evidence (or lack of it) for homeopathy. Skepticat tells it far better than I could, but the admission by Boots of the absence of evidence for homeopathy and that they just sell the stuff  ‘cos their customers want to buy it has been described as a Ratner moment.

That was Wednesday; but today was another significant day for the regulation of quackery.

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Regulating nonsense: my response

The deadline was today, and I only just managed to get my response in to the Department of Health consultation (take a deep breath):

A joint consultation on the Report to Ministers from the DH Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK

…otherwise known as the Pittilo consultation.

I covered the launch of this consultation in August (see Regulating nonsense). Since then, Professor David Colquhoun has blogged his response and urged everyone to respond to this consultation to ‘help to stop Department of Health making fool of itself‘.

David also published the excellent response by someone known as Allo V Psycho. David correctly summarised this response:

‘The document is a model of clarity, and it ends with constructive suggestions for forms of regulation that will, unlike the Pittilo proposals, really protect patients.

I have taken my lead from these responses and concentrated on my unique view of current statutory regulation: that of chiropractors.

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