This is only an attrractor for the Quackometer.
So read the text in full, nicely formatted, with all the embedded links, polease DO READ THE ORIGINAL:
http://www.quackometer.net/blog/2010/02/house-of-commons-evidence-check-homeopathy.html[*QUOTE*]
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The Bleakest Day for HomeopathyFebruary 22, 2010
By Le Canard Noir
MPs call for the closure of NHS homeopathic hospitals.
The much anticipated House of Commons report into the Evidence Check on Homeopathy has now been published and it may well be the report that changes the face of homeopathy in the UK. But more than that, its implications will also be felt around the world.
In a thorough appraisal of the issues and evidence that will become required reading for any health official looking at the public funding and provision of homeopathy, the MPs conclude,
By providing homeopathy on the NHS and allowing MHRA licensing of products which subsequently appear on pharmacy shelves, the Government runs the risk of endorsing homeopathy as an efficacious system of medicine. To maintain patient trust, choice and safety, the Government should not endorse the use of placebo treatments, including homeopathy. Homeopathy should not be funded on the NHS and the MHRA should stop licensing homeopathic products.
The Evidence Check was called to look at the evidence base that has influenced government policy regarding homeopathy. The policy areas focussed on two main issues: the specific funding of homeopathy centres within the NHS and the regulation and labelling of homeopathic products. MPs called for submissions from interested parties about the nature of evidence and how it was influencing policy.
Both areas have come under intense criticism from the MPs. Of course, the central question of evidence into the policy concerning such areas must be the evidence of the effectiveness of homeopathic treatment. The evidence submitted by homeopaths was a complete ragbag, ranging from the selective, the misleading, the irrelevant to the bizarre.
"It is unacceptable for the MHRA to license placebo products—in this case sugar pills—conferring upon them some of the status of medicines."
As such, homeopathy will be under more pressure than it could have conceived possible. It may not be that this government acts on this report – elections are looming – but that is not important. Within PCTs, the NHS will start rethinking and no doubt start unwinding provision for it. There will be a ratchet effect. Bit by bit, funding will stop, never to return. West Kent PCT has done so. The likes of Liverpool, Glasgow, Bristol and London will surely follow. The Medicines Regulator will be under strong pressure to review its stance as it is clearly complicit in misleading the public with how it allows homeopathic products to be labelled.
So, what does the report conclude?
It appears to be a very well thought out document. Firstly, it sets out what its expectations of government would be for making policy on homeopathy:
Our expectations of the evidence base relevant to government policies on the provision of homeopathy are straightforward. We would expect the Government to have a view on the efficacy of homeopathy so as to inform its policy on the NHS funding and provision of homeopathy. Such a view should be based on the best available evidence, that is, rigorous randomised controlled trials and meta-analyses and systematic reviews of RCTs. If the effects of homeopathy can be primarily attributed to the placebo effect, we would expect the Government to have a view on the ethics of prescribing placebos.
The report then starts to look at the evidence, starting with the plausibility problem. It damns homeopathy before dilutions are even mentioned:
We conclude that the principle of like-cures-like is theoretically weak. It fails to provide a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science.
Water memory and the dilution problem are rejected outright. Furthermore, calls for more research into the hypothesis are questioned, "Research funding is limited and highly competitive. The Government should continue its policy of funding the highest quality applications for important scientific research determined on the basis of peer review."
They leave the decision to government funding to be settled by the chief scientists.
We recommend that the Government Chief Scientific Adviser and Professor Harper, Chief Scientist at the DH, get together to see if they can reach an agreed position on the question of whether there is any merit in research funding being directed towards the claimed modes of action of homeopathy.
On the question of clinical evidence, the MPs assess the overall conclusions of the best reviews and conclude simply: "In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos."
However, the Chief Scientist at the Department of Health came under particular criticism for being equivocal about the evidence and appearing to suggest that there was a “lack of agreement between experts working in the field”. The MPs could find no evidence of such a lack of agreement.
And so, again, the MPs ask the Chief Scientists to get together and form an opinion as to whether there is any real controversy here.
On the evidence submitted by homeopaths, they are damning,
We regret that advocates of homeopathy, including in their submissions to our inquiry, choose to rely on, and promulgate, selective approaches to the treatment of the evidence base as this risks confusing or misleading the public, the media and policy- makers.
On the question of funding more clinical research, the MPs again are clear,
There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities.
Even more damningly, they question the ethics of homeopathy trials,
It is also unethical to enter patients into trials to answer questions that have been settled already. Given the different position on this important question between the Minister and his Chief Scientist, we recommend that the Government Chief Scientific Adviser, Professor John Beddington, investigate whether ministers are receiving effective advice and publish his own advice on this question.
The MPs anticipate the reaction of homeopaths that homeopathy works in ‘real life’ scenarios. They look at the various ’satisfaction surveys’ that come out of homeopathic hospitals and conclude,
We do not doubt that homeopathy makes some patients feel better. However, patient satisfaction can occur through a placebo effect alone and therefore does not prove the efficacy of homeopathic interventions.
(I suspect strongly we shall see some homeopaths quote mining this section!)
It is therefore inevitable that the MPs should ask the NHS PCTs to consider whether spending money on homeopathy is cost effective,
We recommend that the Department of Health circulate NHS West Kent’s review of the commissioning of homeopathy to those PCTs with homeopathic hospitals within their areas. It should recommend that they also conduct reviews as a matter of urgency, to determine whether spending money on homeopathy is cost effective in the context of competing priorities.
Given that it is almost certain that homeopathy is nothing but a placebo, should doctors still be allowed to prescribe it? There are feelings that a placebo may well help some patients. However, the MPs again were very straightforward here in their conclusions about prescribing placebos: "When doctors prescribe placebos, they risk damaging the trust that exists between them and their patients."
One of the central arguments from homeopaths is that the NHS should provide the choice to be treated with homeopathy. ‘Choice’ is the big buzz word in health at the moment. The MPs again do not see homeopathy providing extra real choices for patients,
For patient choice to be real choice, patients must be adequately informed to understand the implications of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done, the effectiveness of the placebo—that is, homeopathy—may be diminished. We argue that the provision of homeopathy on the NHS, in effect, diminishes, not increases, informed patient choice.
This thinking is extended to the new concept of ‘personal health budgets’ that are being trialed at the moment: "We recommend that if personal health budgets proceed beyond the pilot stage the Government should not allow patients to buy non-evidence-based treatments such as homeopathy with public money."
And quite critically, the MPs recognised that NHS funding of homeopathy could harm people by appearing to endorse nonsensical treatments. They noted that most people do not understand what homeopathy is – thinking it is a ‘herbal’ treatment.
When the NHS funds homeopathy, it endorses it. Since the NHS Constitution explicitly gives people the right to expect that decisions on the funding of drugs and treatments are made “following a proper consideration of the evidence”, patients may reasonably form the view that homeopathy is an evidence-based treatment.
The overall conclusion must be the bleakest conclusion for the supporters of homeopaths in the UK.
We conclude that placebos should not be routinely prescribed on the NHS. The funding of homeopathic hospitals—hospitals that specialise in the administration of placebos—should not continue, and NHS doctors should not refer patients to homeopaths.
The Royal London Homeopathic Hospital is probably the most famous state funded homeopathy clinic in the world. Its closure will be a bitter blow to all supporters of this quackery. However, it will be a very good thing to all those subjected to quack medicine in India and Africa where homeopaths use the UK state funding of homeopathy as an endorsement for their own dangerous policies and practices. This is a good day for the health of the poor and exploited.
The MPs move on the the licensing of homeopathic remedies and how the MHRA handle it. This is an area I am particularly interested in as I submitted evidence of the failure of the MHRA to uphold their own rules. The first blow to the homeopathic industry is the call for the ending of the Public License of Right which gave exemptions to homeopathic products when the Medicines Act was introduced,
We are concerned that homeopathic products were, and continued to be, exempted from the requirement for evidence of efficacy and have been allowed to continue holding Product Licences of Right. We recommend that no PLRs for homeopathic products are renewed beyond 2013.
This will send shock waves through the manufacturers of sugar pills. My guess is that this is a far more deeply reaching conclusion that they were expecting.
The MPs conclusions about the MHRAs position are quite amusing…
The absence of a requirement to show evidence of efficacy means that the MHRA’s current arrangements would allow a person to seek, for example, a licence for a confectionary product as long as he or she persuaded a number of people that it was a homeopathic product with therapeutic effects. Such a development would, rightly, bring the licensing arrangements into disrepute. We are concerned that the lack of rigour in the MHRA’s licensing processes by, for example, allowing the use of provings is allowing homeopathic products to build medical claims unsupported by any evidence. We conclude that the MHRA should seek evidence of efficacy to the same standard for all the products examined for licensing which make medical claims and we recommend that the MHRA remove all references to homeopathic provings from its guidance other than to make it clear that they are not evidence of efficacy.
The testing of the publics’ understanding of the labeling of homeopathic products was found to be ‘flawed’ "the MHRA’s testing of the public’s understanding of the labelling of homeopathic products is defective."
As I suggested a few weeks ago, the MPs suggest that if there are to be new labels, they should make it clear that there is no active ingredient,
If the MHRA is to continue to regulate the labelling of homeopathic products, which we do not support, we recommend that the tests are redesigned to ensure and demonstrate through user testing that participants clearly understand that the products contain no active ingredients and are unsupported by evidence of efficacy, and the labelling should not mention symptoms, unless the same standard of evidence of efficacy used to assess conventional medicines has been met.
The role of pharmacists in selling these products was questioned.
Pleasingly for me, the MPs directly address my concern about the lack of enforcement of the existing rules. They quote me on how Ainsworths sell remedies for mumps, measles, typhoid and TB and appear to be getting away with it,
Although it goes wider than the scope of this Evidence Check inquiry we must put on record our concern about the length of time the RPSGB appears to be taking to investigate and reach conclusions on cases where it has been alleged that its guidelines on the sale of homeopathic products have been breached. We recommend that the Government enquires into whether the RPSGB, and from the 2010 handover, the General Pharmaceutical Council, is doing an adequate job in respect of the time taken to pursue complaints.
The overall conclusion is damning for the industry and there must be very many worried homeopathic sugar pill retailers,
It is unacceptable for the MHRA to license placebo products—in this case sugar pills—conferring upon them some of the status of medicines. Even if medical claims on labels are prohibited, the MHRA’s licensing itself lends direct credibility to a product. Licensing paves the way for retail in pharmacies and consequently the patient’s view of the credibility of homeopathy may be further enhanced. We conclude that it is time to break this chain and, as the licensing regimes operated by the MHRA fail the Evidence Check, the MHRA should withdraw its discrete licensing schemes for
homeopathic products.
This will indeed be the bleakest day for homeopathy.
Related posts:
The MHRA and the Labeling of Homeopathic Products Further documents have been published after the House of Commons held its enquiry into the evidence base for government policy on homeopathy. There are some real treats in there,...
That’s It for Tunbridge Wells Homeopathic Hospital Reported today in Pulse, Campaigners look to have lost their fight to save a leading homeopathic hospital, in a landmark case that accelerates the treatment’s deepening crisis over NHS funding.West...
Massively Distracting, Cruelly Deceiving Quackery On the eve of the Society of Homeopaths’ symposium in London on homeopathy and AIDS, the SoH issue a press release. It is a statement about how they are warm...
Dispensing with Homeopathy: A Proposal Let’s run with an idea and see where it goes. The 10:23 campaign has now had loads of publicity and Boots have failed to address any of the central...
There Goes My Knighthood Prince Charles’ company, Duchy Originals, has today been told by the Advertising Standards Authority to stop making misleading and untruthful claims in its advertising and to not make claims...
Tags: evidence check, homeopathy, the law
15 Responses to “ The Bleakest Day for Homeopathy ”
Suzanne on February 22, 2010 at 11:20 am
Apologies, I’m a compulsive proof-reader…
“It appears to be a very well though out document.” Should be “thought”
“The report then starts to look at the evidence, startingt with the plausibility problem.” Should be “starting”
A great summary for the lay person. Thanks.
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Teek on February 22, 2010 at 11:38 am
A thorough appraisal of a damming report.
What strikes me is the finality of tone, attempting to draw a line under the government endorsement of magic water. This angle puts fresh pressure on ministers to withdraw all public funds for homoeopathy, straight away – but as you say with elections looming this may not happen. Makes one wonder, however, how many votes would be lost by withdrawing such funds and whether they would be cancelled out by those celebrating the decision to base policy on evidence…
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AndyD on February 22, 2010 at 12:15 pm
What? You didn’t notice “confectionary”?
This is an amazing report. Far more damning than I’d expected from a government committee. Kudos to all who contributed.
But will it have any useful effect?
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Evidence: Government Policy and Homeopathy « Stuff And Nonsense on February 22, 2010 at 3:22 pm
[...] efficacy. David Colquhoun writes of the criticism of the MHRA and includes a summary of the report. Quackometer & [...]
Reply
British MPs Tell Gov’t: Stop Funding Homeopathy « Science-Based Pharmacy on February 22, 2010 at 4:00 pm
[...] The Quackometer: The Bleakest Day for Homeopathy [...]
Reply
JamesC on February 22, 2010 at 5:09 pm
This select committee report makes me very happy. Let’s hope they act on it!
Given that the report, and especially its page of conclusions is available online[1], I’m a tad disappointed that the blog post doesn’t link to the places it quotes from in the report. It seems to be a trend in much skeptical writing of which I’d like to encourage a reversal. I realise that Le Canard Noir usually does provide good links and citations, and that many other good bloggers do. But many don’t and many of the printed popular science books of a skeptical nature also fail in this regard to save space or stop themselves looking inaccessible to the so-called general public. But when it comes to talking about evidence, then it behooves us to provide clear and precise citations and preferably direct links online and at very least endnotes with full citations in print. If I tried to publish a humanities journal article without every quote or appropriated idea or research cited I would be laughed at. I’m not saying blog articles have to be as rigorous as a peer-reviewed journals(far from it!), but I think there is a long-term benefit to leading by example. Especially in that most of the quack sites do not do this and if we can gradually create a climate where blog posts without clear citations/notes are seen as less reliable, then we are educating the public in looking for and following up evidence for statements that are made. (There are wordpress plugins for footnotes/sidenotes to make this easier. btw.)
Good summary of the important conclusions of the report.
Just my two bits,
-JamesC
[1]http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4507.htm
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Andy Lewis on February 22, 2010 at 5:18 pm
James
This post was written during the embargo period as I was sent a copy prior to publication – I was not aware of any online sources at the time of writing. I felt it useful that other people could see the main summary points before the report was widely distributed. I have not gone back yet to link to any primary sources, but I see you posted a link.
Thanks
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JimR on February 22, 2010 at 9:48 pm
The power of the ellipsis…
1). FULL TEXT:
“When the NHS funds homeopathy, it endorses it{. Since the NHS Constitution explicitly gives people the right to expect that decisions on the funding of drugs and treatments are made “following a proper consideration of the evidence”, patients may reasonably form the view }that homeopathy is an evidence-based treatment.”
AFTER EDIT:
“When the NHS funds homeopathy, it endorses it…that homeopathy is an evidence-based treatment.”
2.) FULL TEXT:
“There has been enough testing of homeopathy and{ plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and }we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities.”
AFTER EDIT:
“There has been enough testing of homeopathy and…we cannot see how further research on the efficacy of homeopathy is justified…”
3). FULL TEXT:
“We conclude that the principle of like-cures-like is{ theoretically weak. It fails to provide }a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science.”
AFTER EDIT:
“We conclude that the principle of like-cures-like is…a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science.”
Very, very scary!!!
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Homeopathy < Reality. Again. « Cubik’s Rube on February 22, 2010 at 10:27 pm
[...] Le Canard Noir is all over this, of course, looking through the whole thing in great detail. I’m glad that the authors of the report seem to understand this point: We do not doubt that homeopathy makes some patients feel better. However, patient satisfaction can occur through a placebo effect alone and therefore does not prove the efficacy of homeopathic interventions. [...]
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Dr Andrew Sikorski on February 22, 2010 at 10:59 pm
Regrettably the waste of countless millions of taxpayer pounds through 25-30% use of private ISCATS (1)seems less troublesome than removing fluffy choice of treatments not yet proven to be harmful to mammals nor plants. You could do even better yet! Actually, once homeopathy were to finally croak, what would you be left to get incensed about?
1.
http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4125097&c=2Reply
Le Canard Noir on February 22, 2010 at 11:10 pm
The way I see this is very simple Dr Sikorski. If society and its government cannot sort out an obvious nonsense like homeopathy then it really has no hope with much more substantial issues.
Homeopathy is really a pons asinorum for the parliament evidence check. Failure to cross that bridge would make total asses of them. They have made it due to the efforts of a small band of sane MPs.
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Dr Andrew Sikorski on February 22, 2010 at 11:33 pm
so what would you get incensed about?
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Jeff Keogh on February 23, 2010 at 3:36 am
I can’t speak for le Canard Noir, of course, but…
I personally get incensed at any evidence-free twaddle that is peddled as reality to the detriment of the unwary. Homeopathy is merely one such bucket of piffle. Its absence, while a very positive thing, would still leave hundreds of other pifflebuckets to be dealt with.
Homeopathy and its ilk are not the problem in themselves, other than that they are symptomatic of a deeper issue, and that is the propensity of people to (easily) fall victim to magical thinking. If people would learn to think critically as a matter of course then homeopathy, chiropractic, reiki etc would take care of themselves.
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AndyD on February 23, 2010 at 3:40 am
Oh, I get it! Sceptics are really just grumpy cynics just looking for things to complain about – and homeopaths are just providing a service for them to target. Okay, yep. I see what you’re saying.
Okay then, I vote we keep homeopathy around so we don’t have to find a new hobby. I don’t really like stamps.
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Matthew Holloway on February 23, 2010 at 6:10 am
Just posted this on facebook and chose the icon of “Powered by positive” that’s in your left-hand sidebar… a good summary for Homeopathy!
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