Homeopathic Motions

There is an early day motion (EDM) before the House of Commons, protesting risks to funding of NHS homeopathic hospitals.  As of 27^th September 2007 it had collected 197 signatures from Members of Parliament.

It contains a number of impressive assertions.  Are they relevant?  Are they backed up by good evidence?  Let’s examine them one at a time.

 “That this House welcomes the positive contribution made to the health of the nation by the NHS homeopathic hospitals  …” 

This is, to put it mildly, open to question.  Systematic reviews of published trails call into question whether this therapy has any effect, beyond that of a placebo.  Let’s look at the evidence.

A Lancet paper in 1997 [1] gave some hope to the advocates of homeopathy.  In a review of 89 studies the authors said that their findings “were not compatible with the hypothesis that the clinical effects of homoeopathy are completely due to placebo”.  This part is often quoted by homeopaths (see here, for example).  They forget that the paper also “… found insufficient evidence from these studies that homoeopathy is clearly efficacious for any single clinical condition  …”

A re-analysis of the data used in this paper [2] concluded that “in the study set investigated, there was clear evidence that studies with better methodological quality tended to yield less positive results.”  Another review in 2000 came to the same conclusion [3].

A more recent evaluation of published trails came to the conclusions that their findings were “… compatible with the notion that the clinical effects of homoeopathy are placebo effects.” [4]

Commenting on the body of evidence Professor Ernst, the UK’s only professor of Complementary Medicine, said: “So the conundrum of homeopathy seems to be solved.  ‘Heavens!’ I hear the homeopathic fraternity shout. ‘We need more research!’ But are they correct? How much research is enough to show that any treatment does not work (sorry, is not superior to placebo)? Here we go full circle: should we really spend several lifetimes in order to arrive at a more robust conclusion?” [5]

Here is the point:  the most reliable evidence says that homeopathy, and hence homeopathic hospitals, have not made a contribution to the health of the nation beyond the administration of placebos.

 “That this House … notes that some six million people use complementary treatments each year …” 

There are two sleights of hand here.  First the EDM moves from talking about a making people healthier to popularity.  This just does not follow.  Popularity does not infer effectiveness. Second, it slides away from homeopathy and introduces “complementary treatments”.  The two are not, of course, interchangeable.  Homeopathy is a sub-set of the complimentary treatments available.  Given that the EDM is about homeopathic hospitals, I’ll stick with homeopathy.

 “That this House … believes that complementary medicine has the potential to offer clinically-effective and cost-effective solutions to common health problems faced by NHS patients  …” 

First note that this is a statement of belief.  Does it hold up to scrutiny?

In this debate clinical effectiveness should be the decisive factor: if a treatment is not clinically-effective it can never be cost-effective.  As we have seen, the evidence is that homeopathy works no better than a placebo.  Also, that “potential” is still being talked about for a practise that is over 200 years old must surely be a worry!

Even some advocates of homeopathy concede that its cost-effectiveness is unknown.  Take the evidence offered to the House of Lords Select Committee On Science And Technology (sub-committee) during hearings on allergy by one Kate Chatfield.  She sits on the The Society of Homeopaths Research and Research Ethics Committees and is a director of the Galway College of Homeopathy.  When questioned on the cost-effectiveness of homeopathy against conventional treatment she, reportedly, responded: “.. In terms of cost effectiveness, we do not have enough information on that either.” [Q518, p11.  Note: This is, as yet, unpublished.  Neither Members nor witnesses have had the opportunity to correct the record]

Now to the specific conditions mentioned.  We have already seen that Linde et al [1] “… found insufficient evidence from these studies that homoeopathy is clearly efficacious for any single clinical condition  …”

 However, the EDM asserts complementary medicine’s effectiveness in treating the following raft of conditions: musculoskeletal and other chronic pain; eczema; depression; anxiety; insomnia; allergy; chronic fatigue and irritable bowel syndrome. 

Starting with eczema and allergy together and adding in asthma for good measure; what is the evidence?  These were covered in the House of Lords Science and Technology Select Committee report on “Allergy”.  Professor Ernst told the committee that “there are virtually dozens of complementary therapies that have been submitted to clinical trials … for no treatment modality is there good evidence that it is clinically effective in asthma, atopic eczema or hayfever“ [6].

Let’s also remember that this is meant to be about homeopathic hospitals.  So what evidence is available on the effectiveness of homeopathy for these conditions?

The best evidence is found in review papers.  Why?  This is because, as we have already seen, homeopathy research often suffers from small, poor quality trials which can give misleading results.  Also the one-in-twenty chance that a finding (positive or negative) is the result of statistical variation tend to undermine individual findings.

Using the Cochrane Library and Bandolier the following relevant reviews can be found.

Chronic asthma: “Not enough evidence from trials to determine whether or not homeopathy can help improve asthma  …” [7]

Depression: “Evidence for the effectiveness of homeopathy in depression is limited because of a lack of high-quality clinical trials.” [8]

Pain: “There is no evidence to demonstrate the relative efficacy of various homeopathic remedies in comparison to standard drug treatment. All existing comparative trials are of poor methodological quality.” [9]

These resources do not list reviews on any of the other conditions mentioned by the EDM.

 “That this House … expresses concern that NHS cuts are threatening the future of these hospitals; and calls on the Government actively to support these valuable national assets.” 

Given the evidence that homeopathy is a placebo; can this strong expression of support really be justified?  I think not.

 References 

[1]       Linde, K. et al.  “Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. “  The Lancet 1997; 350:834-843.

[2]       Linde, K. et al, “Impact of study quality on outcome in placebo-controlled trials of homeopathy”, J Clin. Epidemiol. 1999 Jul;52(7):631-6. 

[3]       Cucherat M, Haugh M C, Gooch M, Boissel J P. “Evidence of clinical efficacy of homeopathy: a meta-analysis of clinical trials.” European Journal of Clinical Pharmacology. 2000;56(1):27-33.

[4]       Shang, A. et al. “Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy” The Lancet 2005; 366:726-732.

[5]       Ernst, E. “The truth about homeopathy”, Br. J. Clin.  Pharmacol. 2007; pp 1-2

[6]       House of Lords, Science and Technology – Sixth Report, 26 September 2007, Allergy, §8.28

[7]       McCarney RW, Linde K, Lasserson TJ. “Homeopathy for chronic asthma.” Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD000353. DOI: 10.1002/14651858.CD000353.pub2

[8]       Pilkington K, Kirkwood G, Rampes H, Fisher P, Richardson J. “Homeopathy for depression: a systematic review of the research evidence.” Homeopathy. 2005;94(3):153-163.

[9]       Ernst E. “Classical Homeopathy Versus Conventional Treatments: A Systematic Review.” Perfusion 1999;12:13-15