The random thoughts of a sceptical activist

NHS

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.

Big business in Texas

As a last hope for cancer sufferers, his name regularly appears in the media with many a fund-raising appeal launched to enable sufferers to travel to the US to visit his clinic and be treated by the great man himself.

Even a cursory search of the Internet will find many grateful customers of Dr Stanislaw R Burzynski telling how he single-handedly saved their lives, when the NHS or other cancer experts had failed or who could do no more.

If it was your last hope — or the last chance for your child — then who could blame you for wanting to give it a try?

After an uncritical article in The Observer about the heartbreaking tale of a young girl diagnosed with a brain tumour and whose parents were desperate to raise the necessary money to take their daughter to see Dr Burnzynski for treatment, Andy Lewis — quite understandably — felt compelled to write about it: The False Hope of the Burzynski Clinic.

It was not long before Andy received a threatening email from someone claiming to represent the clinic. The tactics this representative used to try to silence Andy and to force him to take his blog post down can be gauged by the title of Andy’s subsequent post: The Burzynski Clinic Threatens My Family. Despicable.

Because there are so many unanswered questions about his treatment, the spotlight of skeptical thinking has been shining brightly on the controversial promoter of his own proprietary, ‘pioneering’ cancer treatments, but the intensity has been turned up all the way to eleven in the aftermath of these and other recent threats.

There has been an avalanche of blog posts in the last few days and it is to be hoped that the name of Burzynski will be appearing high up in search rankings alongside some more skeptical comment that the clinic might be used to or want. The blogger Josephine Jones is trying to keep the list of posts up to date: Stanislaw, Streisand and Spartacus.

Even Cancer Research UK felt they had to speak up: Hope or false hope?

Continue reading