Activism

Currently the society is encouraging people to submit to the NHS Lothian consultation on homeopathy.

Keir Liddle wrote this piece which appeared in the Edinburgh Evening news and we have already submitted the following statement to the consultation:

Classical homeopathy originated in the 19th century with Samuel Christian Friedrich Hahnemann (1755-1843) as an alternative to the standard medical practices of the day, such as phlebotomy or bloodletting. Hahnemann rejected the notion that disease should be treated by letting out the offensive matter causing the illness. In this, he was right. On the other hand, he argued that disease should be treated by helping the vital force restore the body to harmony and balance. In this, he was wrong.

Classical homeopathy is generally defined as a system of medical treatment based on the use of minute quantities of remedies that in larger doses produce effects similar to those of the disease being treated. Hahnemann believed that very small doses of a medication could have very powerful healing effects because their potency could be affected by vigorous and methodical shaking (succussion). Hahnemann referred to this alleged increase in potency by vigorous shaking as dynamization. Hahnemann thought succussion could release “immaterial and spiritual powers,” thereby making substances more active. “Tapping on a leather pad or the heel of the hand was alleged to double the dilution”

Like most of his contemporaries, Hahnemann believed that health was a matter of balance and harmony, but for him it was the vital force, the spirit in the body, that did the balancing and harmonizing, that is, the healing.

Hahnemann claimed that most chronic diseases were caused by miasms and the worst of these miasms were the ‘psora.’ The evidence for the miasm theory, however, is completely absent.

Homeopaths refer to “the Law of Infinitesimals” and the “Law of Similars” as grounds for using minute substances and for believing that like heals like, but these are not natural laws of science. If they are laws at all, they are metaphysical laws, i.e., beliefs about the nature of reality that would be impossible to test by empirical means. Hahnemann’s ideas did originate in experience. That he drew metaphysical conclusions from empirical events does not, however, make his ideas empirically testable. The law of infinitesimals seems to have been partly derived from his notion that any remedy would cause the patient to get worse before getting better and that one could minimize this negative effect by significantly reducing the size of the dose. Most critics of homeopathy balk at this “law” because it leads to remedies that have been so diluted as to have nary a single molecule of the substance one starts with. Hahnemann came up with his dilution idea prior to our understanding of atoms and molecules. The greatest dilution that is likely to contain at least one molecule of the original substance is 12C [dilute by a factor of 100 twelve times]. Hahnemann advocated 30C dilutions for most purposes.

Working on the principle of similarities, Hahnemann created remedies for various disorders that had symptoms similar to those of the substances his provers had taken. However, “….methods of proving are highly personalised and of individual relevance to the homoeopath or experimenter.”* In other words, one hundred homeopaths preparing a remedy for one patient might well come up with one hundred different remedies.

Hahnemann may be praised for empirically testing his medicines, but his method of testing is obviously flawed. He wasn’t actually testing the medicines for effectiveness on sick people but for their effects on healthy people. In any case, he had to rely upon the subjective evaluations of his provers, all of whom were his disciples or family members and all of whom were interrogated by the master himself. (Later investigators would use more controlled methods of proving.*) But even if his data weren’t tainted by the possibility of his suggesting symptoms to his provers or their reporting symptoms to impress or gain the approval of the master, it is a belief in magic that connects this list of symptoms with the cure of a disease with similar symptoms. In logic, this kind of leap of reasoning is called a non sequitur: It does not follow from the fact that drug A produces symptoms similar to disease B that taking A will relieve the symptoms of B. However, homeopaths take customer satisfaction with A as evidence that A works.

While we might excuse Hahnemann for not doing properly controlled experiments, we shouldn’t be so generous toward modern homeopaths for not understanding the nature of anecdotes and testimonial evidence. However, we can’t accuse them of not doing any properly designed controlled experiments. But we can blame them for not understanding some fundamental principles of evaluating the results of controlled experiments that involve giving drugs or even inert substances to humans.

Today’s homeopaths should know that because of the complexity of each individual human body, fifty different people may react in fifty different ways to the same substance. This makes doing clinical trials on potential medicines a procedure that should rarely claim dramatic results on the basis of one set of trials. Finding a statistically significant difference, positive or negative, between an experimental (drug therapy) group and a control group in one trial of a drug should usually be taken with a grain of salt. So should not finding anything statistically significant. It is not uncommon for twenty trials of a drug to result in several with positive, several with negative, and several with mixed or inconclusive results.

Yet, despite the fact that of the hundreds of studies that have been done on homeopathic remedies the vast majority have found no value in the remedies, some defenders of homeopathy insist not only that homeopathic remedies work but they claim they know how they work. It seems, however, that scientists like Jacques Benveniste, who claim to know how homeopathy works, have put the cart before the horse. Benveniste claims to have proven that homeopathic remedies work by altering the structure of water, thereby allowing the water to retain a “memory” of the structure of the homeopathic substance that has been diluted out of existence (Nature Vol. 333, No. 6176, pp. 816-818, 30th June, 1988).* The work in Benveniste’s lab was thoroughly discredited by a team of investigators who evaluated an attempted replication of the study published in Nature. Neither Benveniste nor any other advocate of the memory-of-water speculation have explained how water is so selective in its memory that it has forgotten all the other billions of substances its molecules have been in contact with over the millennia. One wonders in vain how water remembers only the molecules the homeopath has introduced at some point in the water’s history and forgets all those trips down the toilet bowel, etc. (Benveniste even claims that a homeopathic solution’s biological activity can be digitally recorded, stored on a hard drive, sent over the Internet, and transferred to water at the receiving end. He was a successful biologist working in a state-run lab until he started making such claims, which have cost him his status and reputation as a reputable scientist. He is now considered by his critics (such as James Randi) to be another Blondlot.) Since homeopathic remedies don’t work any better than placebos or doing nothing, there is no need for an elaborate explanation as to how they work. What there is need of is an explanation for why so many people are satisfied with their homeopath despite all the evidence that homeopathic remedies are inert and no more effective than a placebo or just letting an illness run its natural course.

A review of the reviews of homeopathic studies has been done by Terence Hines (2003: 360-362). He reviewed Taylor et al. (2000), Wagner (1997), Sampson and London (1995), Kleijen, Knipschild, and ter Riet (1991), and Hill and Doyon (1990). More than 100 studies have failed to come to any definitive positive conclusions about homeopathic potions. Ramey (2000) notes that

Homeopathy has been the subject of at least 12 scientific reviews, including meta-analytic studies, published since the mid-1980s….[And] the findings are remarkably consistent:….homeopathic “remedies” are not effective.

It is ridiculous that any publicly funded NHS board still funds homeopathy particularly when NHS Scotland Health Quality strategy makes it abundantly clear that treatments offered should be Effective. That patients should receive the most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

Also on efficency the NHSScotland Efficiency and Productivity: Framework for SR10 states that care should be evidence based.

As homeopathy is neither efficient or effective, by NHS Scotlands own definitions, it is remarkable that it is still being funded.

We would encourage all members of the society and like minded individuals to submit to this consultation – details below:

NHS Lothian is considering whether it should pay for homeopathy services. Your response to this consultation will help NHS Lothian understand the importance of homeopathy to local people.

From: NHS Lothian

There is increasing demand for health services and increasing financial pressures in the current economic climate. NHS Lothian also faces the challenge of being the health board with the biggest population growth in Scotland. NHS Lothian is looking at the way it provides all its services, to see if it can provide them more efficiently and whether there are any services that it can reduce or stop in order to protect other priority services.

Some Scottish Health Boards and some NHS areas in England do not provide NHS homeopathy services. Some have decided to stop providing NHS homeopathy services and some are currently paying for these services.

Note: This consultation is about homeopathy and not about herbal remedies.

DOWNLOAD: Should NHS Lothian pay for homeopathy? – A Consultation

Take the survey

In addition to being able to fill in the survey or reply by letter, public meetings have been organised across Lothian if you would like to discuss the consultation:

  • East Lothian Thursday 4 October at 3.00 pm Musselburgh East Community Learning Centre Haddington Rd, Musselburgh , EH21 8JJ
  • West Lothian Tuesday 9 October at 10.30 am Howden Park Centre, Howden, Livingston,EH54 6AE
  • Midlothian Wednesday 10 October at 6.00 pm Dalkeith Arts Centre, White Hart Street, Dalkeith
  • Edinburgh Monday 29 October at 2.30pm NHS Lothian, Waverley Gate, Waterloo Place, Edinburgh EH1 3EG

If you are not able to attend your local meeting, you can come along to another one. They are public meetings so anyone may attend on the day, but it would be helpful to have an idea of numbers so please emailhomeopathy@nhslothian.scot.nhs.uk or phone 0131 465 5544 to register your name and contact details.

WE encourage Lothian based skeptics to attend these meetings and to make our voice heard.  Details of NHS Lothian spending on homeopathy from a previous 21st Floor FOI request are given below:

NHS Lothian provided the following information on the cost of homeopathic services:

NHS Lothian cost of homeopathic services
Cost
Area 03/04 04/05 05/06 06/07 07/08
Service level agreement with NHS Greater Glasgow 24909 25879 26193 26700 27322
St Johns Service 22390 23262 23544 24000 24560
Dalkeith Clinic inc Leith CTC 57980 53629 43867 61517 48680
Total 102987 92063 78751 112217 84803

The following figures for patients attending homeopathic services were provided:

NHS Lothian homeopathic patients
Year New patients Return Patients Total
2003/04 214 997 1211
2004/05 205 1257 1462
2005/06 295 1457 1752
2006/07 273 1806 2079
2007/08 144 1099 1243
Total 1131 6616 7747

You may wish to mention in your submissions that the current provision of homeopathy by NHS health boards in Scotland directly goes against the ambitions of the NHS Scotland healthcare quality strategy.

This strategy mandates that healthcare should be effective and efficient. Homeopathy fails on both these counts and as such it is ridiculous that it this ineffective and inefficient treatment is available free of charge on the NHS and funded by the taxpayer.

It may also be worth mentioning that reducing or removing NHS provision of homeopathy will not limit patient choice. As private provision is still readily available.

Another nail in the coffin of NHS provision is that the NHS could fall foul of existing laws regarding the licensing and prescribing of homeopathic remedies. Unlicensed medicines number in the thousands and make up the majority of homeopathic prescriptions, while there are only 50 licenced homeopathic medicines.

Tax payer funded health services should simply not be providing treatments that are unlicensed, ineffective and inefficient.