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 Hospital: Homeopathy: another day in court + another defeat.
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.
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.
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.
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.
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?
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:
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.
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.
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.
Spot 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.
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.
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
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.  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’: 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.
We already know that homeopathy in the NHS has been in steep decline for the last few decades: 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.
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
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
What does the two-decade-old ‘endorsement’ by The Times really say?
Any reader not aware of the current fuss and bother over the What Doctors Don’t Tell You magazine can find a comprehensive list of blog posts, etc curated by Josephine Jones: WDDTY: My Master List.
In a recent spat — after The Times published an article by Tom Whipple (Call to ban magazine for scaremongering) — WDDTY posted a scan of part of a 1989 Times article that appeared to praise their original (online subscription) publication of the same name, saying it was “A voice in the silence”.
WDDTY use this same endorsement 24 years later on their main website, the WDDTY subscription website for their latest glossy, supermarket edition (although they get the quote mixed up with others) and in the glossy magazine itself.
When I submitted my complaints about claims made on chiropractic websites in June 2008, a fundamental requirement regulating what chiropractors could claim — firmly embedded in their Code of Practice — was that they only advertise consistent with guidance issued by the Advertising Standards Authority (ASA).
Chiropractors must justify public trust and confidence by being honest and trustworthy.
C1 Chiropractors must act with integrity and never abuse their professional standing.
C1.6 may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority. If chiropractors, or others on their behalf, do publicise, the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way. It must not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters. It must not put pressure on people to use chiropractic.29
29 For example, by arousing ill-founded fear for their future health.
This clearly mandates chiropractors to ensure any advertising complies with ASA guidance, remembering that ASA guidance includes the CAP Code, other guidance and their adjudications.
In prosecuting my complaints, the GCC inexplicably forgot all about the requirement to be consistent with ASA guidance and came up with some arbitrary standard of evidence for compliance. The Professional Conduct Committee begged to differ even with that and effectively allowed any old evidence to be used to substantiate chiropractors’ claims. To understand the whole story, see Humpty Dumpty regulation.
They are organic, but this isn’t why I used to buy it. I just liked the rich, creamy taste.
Yes, I used to buy it.
On Twitter yesterday, @GhostOMichael, a follower of @RhysMorgan, tweeted a link to a page on Yeo Valley’s website (cached) that I found worrying: it told how Yeo Valley ‘treat’ their cows with homeopathy. (That page has disappeared and has been replaced with this one. Thanks to Jaxxson for pointing it out.)