Nov 13 2015

Homeopathy on the Ropes

The British National Health Service (NHS) is considering blacklisting homeopathy prescriptions from general practitioners. While this would have an overall small effect on the homeopathy market, it is politically potentially very significant.

The NHS currently spends about £4m on homeopathy each year, of which only £110,000 is from GP prescriptions. The rest is from homeopathic hospitals (yes, hospitals). The real market, however, is in over the counter homeopathic products.

In the UK, Europe and the US homeopathy has ballooned into a multi-billion dollar industry. It is now potentially, it seems, the victim of its own success. When it was smaller it essentially flew under the radar – regulators and politicians didn’t think it was worth spending political capital to reign in a fringe treatment that people either wanted or did not know or care about.

In the US the FDA specifically decided to let the homeopathic industry regulate itself, because it was simply too small for them to spend their resources on. That has now changed.

The NHS has a blacklist, called Schedule 1, of drugs that cannot be prescribed by GPs, because either there is a cheaper or better alternative, or because the treatment simply does not work. That is the question they will take up in 2016 – should all homeopathic products be placed on Schedule 1?

Meanwhile, the FDA is reconsidering its regulation of homeopathy. The FTC (Federal Trade Commission) is doing the same. Both organizations have taken public comments, and we were sure to express our opinion.

As regular readers here know (but much of the public does not) homeopathy is pure snake oil. Homeopathic potions are based on prescientific magical ideas, like sympathetic magic, and are often diluted to the point that no active ingredients remain behind.

Five year ago the UK Parliament prepared a detailed report on homeopathy, concluding that it was essentially witchcraft. There is no possible mechanism by which it can work, and the clinical evidence shows that it does not work. They recommended it essentially be abolished in the UK, but politicians have mostly ignored the recommendations.

A similar review in Australia concluded that there is no evidence that homeopathy works for anything. The Swiss did their own review, coming to the same conclusion, but then proponents were unhappy so they created a follow up panel packed with homeopaths and sympathizers, who put a positive spin on the review and declared victory.

As homeopathy is coming under fire again, it is instructive to see how proponents defend it. You will notice that they rarely try to cite published scientific evidence to defend homeopathy because in the arena of published evidence, they lose. They may be able to cherry pick their studies and fool a naive audience, but once they acknowledge that published evidence is an appropriate criterion to use, they have essentially lost.

In this case at least the published quotes in the BBC article are typical of the strategies used. They begin with the argument, “Hey, look over there.”

But Dr Helen Beaumont, a GP and the president of the Faculty of Homeopathy, said other drugs such as SSRIs (selective serotonin reuptake inhibitors) for depression would be a better target for saving money, as homeopathic pills had a “profound effect” on patients.

This, of course, is a non-sequitur. Because other treatments may be on thin ice when it comes to the evidence (just for the record, the case against SSRIs is massively overstated) does not in any way let homeopathy off the hook.

She finishes with a naked assertion – as if saying something enough times makes it true. If homeopathy had a “profound effect” on patients it would be a simple matter to show this profound effect in clinical trials. But clinical trials show there is no profound effect, in fact there is no effect at all.

Next up is appeal to patient freedom and anecdotal evidence:

Patient choice is important; homeopathy works, it’s widely used by doctors in Europe, and patients who are treated by homeopathy are really convinced of its benefits, as am I.”

This is not about patient choice – this is about quality control in the health care profession. Patients do not want the choice to choose worthless treatments. Most patients don’t know what homeopathy actually is, and scandalized when they find out they have been ripped off. Others are convinced by the placebo effect, which does not justify a treatment. Placebo effects can convince patients that anything has benefits, that does not make it true.

In desperation, some homeopaths and defenders of alternative treatments try to argue that placebo effects are powerful and sufficient to justify a treatment. The evidence simply does not support this position. Placebo effects are small, transient, and subjective. They are mostly artifacts and illusions, not a real benefit.

We may now be at a historic moment when the political will is sufficient to get rid of or at least marginalize homeopathy. There is certainly sufficient evidence to conclude that homeopathy can’t and doesn’t work. There is no scientific debate. This is a solid conclusion based upon way more evidence than is necessary.

That fact, unfortunately, was not enough to kill homeopathy. Now, however, two other facts are conspiring against this pseudoscience. The first, as I stated, is its own success. The industry has grown large enough to get the attention of regulatory agencies, and that attention is not favorable.

Further, rising health care costs are providing the political motivation to weed useless treatments out of the health care system. For example:

Minister for Life Sciences, George Freeman, told the BBC: “With rising health demands, we have a duty to make sure we spend NHS funds on the most effective treatments.”

It is sad that simply making a rational and science-based argument is insufficient for regulators and politicians to do the right thing. The case against homeopathy is as strong as it can be. It is open and shut. If this is insufficient to get rid of it, then no amount of evidence will ever be enough.

The political will to do the right thing has to be based on something else, apparently. Now we may be seeing that political will, fueled by a desire to contain rising health care costs. Worthless treatments are never cost effective, no matter how cheap they are. Further, the homeopathic industry is now big enough to be seen in the light of corporate greed and excess. Big Homeopathy is in the cross hairs.

Still, this will be an uphill battle. The “health care freedom” movement has made political inroads, and they have their rhetoric down (as you can see above). The perception of “freedom” is a difficult hurdle to get over. We have to make it clear that this is not about the freedom of patients to choose which legitimate treatment they want, but the freedom of snake oil salesmen to con the public with worthless potions, dressed up like real medicine, and aided by a complicit regulatory regime.

Addendum: I received some further information from The Good Thinking Society, which played a major role in the NHS decision to review homeopathy. I certainly want to give them full credit for the work they did. Here is the extra information they provided:

The whole story came about because the Good Thinking Society (the charity that I and Simon Singh work on) have spent the last twelve months in length legal correspondence with the Department of Health over. It is our work that all of the newspapers are covering today.

We (and our lawyers) poured over all of the regulations, developed this argument and put it to the Department of Health. When they refused to act back in June, we threatened them with a Judicial Review – effectively, suing the government because their decision is unlawful. It was our threatened legal action that has pushed the Department to make this unprecedented announcement, so it’s a real victory for our long and time-consuming campaign.

There’s more about it on our site:

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