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HOMEOPATHYWITHINTHENATIONALHEALTHSERVICE,UK

Some people take the position that public money should not be spent on homeopathybecause “there is no proof that it works” or “tax-payers money shouldn’t be spent onplacebos”. However, very few people have access to the facts needed to weigh up thisargumenteffectively,sobelowaresomereliablefactsonHomeopathyandtheNHS.

Howmuchisspentonhomeopathy?

• In2016,just£92,412wasspentonhomeopathyprescriptionsfromatotalexpenditureof£9.2billion.1

• OutofthetotalNHSbudgetof£100billionayear,£4million(0.004%)isspentonHomeopathy2ifyouincludeeverythingfromrunningthehospitalsdepartmentstopayingthedoctors.

Whenconsideringvalueformoney,itshouldberememberedthatifhomeopathypatientswerenottreatedwiththisservice,theywouldhavetobetreatedbyotherdepartmentsusingmoreexpensiveconventionaldrugs.

HomeopathyshouldbeconsideredinthesamewayasallotherNHStreatmentsSomepeoplearguethattheNHSshouldnotpayforhomeopathybecausewedonotknowthat itworks,whereas conventionalmedical drugs are ‘tried and tested’. Surprisingly thisissueisn’tactuallyasclear-cutasonemightthink.

Analysis by the British Medical Journal’s (BMJ)Clinical Evidence3 shows that just 11% of3,000commonlyusedNHStreatmentsareknowntobebeneficial:

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Thisdataclearly indicatesthattheNHSpaysformanytreatmentsbesideshomeopathyforwhichtheevidenceisstillunclear.

WhatevidenceistherethathomeopathyhelpsNHSpatients?

Fivepublished‘observationalstudies’carriedoutfrom1999tothepresentdayhavetrackedthe outcome of patients being treated at NHS homeopathic hospitals. These studiesconsistentlyshowthatpatientsimproveclinicallyfollowinghomeopathictreatment(oftenfromchronic,difficulttotreatconditions);somealsohighlightareasofpotentialeconomicbenefit for theNHSasawhole in termsof reducedprescribingofconventionaldrugs.Forexample:

The largest observational study at Bristol Homeopathic Hospital followed over6,500consecutive patients with over 23,000attendances in a six-year period4. 70% offollow-uppatientsreportedimprovedhealth;50%reportedmajorimprovement.ThemostcommondiagnosticgroupswereDermatology,Neurology,Rheumatology,Gastroenterology,Psychiatry andEar,Nose&Throat. The largest improvementswere reported in childhoodeczema or asthma, and in inflammatory bowel disease, irritable bowel syndrome,menopausalproblemsandmigraine.

Theresultsofthis2005Bristolstudyhavebeenconfirmedbyamorerecentobservationalstudy, published in 2016, involving an audit of just under 200 patients. Theauditdemonstratedthatpatientswithlong-termconditionswhocomeunderhomeopathiccare experience statistically significant improvements in their presenting symptoms andwellbeing.5Atotalof198patientswereassessedover1to5consultationsusingapatient-

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reported outcome measure (MYMOP2). The most common conditions seen wereneoplasms,psychologicalandgenitourinarycomplaintswhilethemostcommonlyreportedsymptoms were pain, mental symptoms and tiredness/fatigue. Intention-to-treat analysisshowedthatameanMYMOP2scorechangeof1.24fromthefirsttolastconsultationwasachieved,withimprovements being statistically significant for both completers and non-completers(p<0.001).A 500-patient survey at the Royal London Homeopathic Hospital showed that manypatients were able to reduce or stop conventional medication following homeopathictreatment.6Theextentofimprovementvariedbetweendiagnosese.g.72%ofpatientswithskin complaints reported being able tostop or reduce their conventional medication; forcancer patients there was no reduction. The study also showed thatmany patients seekhomeopathybecauseoftheirconcernsaboutthesafetyofconventionaltreatment.

When assessing these clinical results it is important to remember that NHS patients areusually referred for homeopathy because conventional medicine has failed to givesatisfactoryresults,orconventionaltreatment iscontra-indicated intheircase.Onehastoask,ifthesehomeopathyserviceswerenotavailable,whocouldtreatthese40,000peopleinstead?Howethical is it toremoveaservicethat iscurrentlyvaluedbypatients,withoutbeingabletoofferthemaviablealternativetreatment?InterestingrelatedresearchfromFrance

HomeopathyiswidelyusedinFranceandamajorstudyfollowing8559patientsattendingGPpracticeswasusedtoassesstheeffectivenessofhomeopathictreatment.7TwokeyfindingsoftheEPI3project:

• Upperrespiratorytractinfections(URTIs)–patientstreatedbyGPstrainedinhomeopathydidaswellclinicallyasthosetreatedwithconventionalmedicine,butusedfewerconventionaldrugs8

518adultsandchildrenwithURTIswhoconsultedGPscertifiedinhomeopathyhadsimilarclinicalresultstothosetreatedbyconventionalGPs,buthadsignificantlylowerconsumptionofantibiotics(OR=0.43,CI:0.27–0.68)andantipyretic/anti-inflammatorydrugs(OR=0.54,95%CI:0.38–0.76).

• Musculoskeletaldisorders(MSDs)–patientstreatedwithhomeopathydidaswellclinicallyasthosetreatedwithconventionalmedicine,butusedonlyhalftheamountofnon-steroidalanti-inflammatorydrugs(NSAIDs)andhadfewerNSAID-relatedsideeffects9

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1153eligiblepatientswithMSDwerefollowedfor12months,comparinggroupswhoreceivedhomeopathy(N=371)orconventionalmedicine(CM;N=272),oramixedapproachinvolvingbothapproaches(N=510).Thetwelve-monthdevelopmentofspecificfunctionalscoreswasidenticalforallgroups(p > 0.05).Afteradjustingforpropensityscores,NSAIDuseover12monthswasalmosthalfinthehomeopathygroup(OR,0.54;95%CI,0.38-0.78)ascomparedtotheCMgroup;nostatisticallysignificantdifferencewasfoundinthemixedgroup(OR,0.81;95%CI:0.59-1.15).MSDpatientsseenbyhomeopathicphysiciansshowedasimilarclinicalprogressionwhenlessexposedtoNSAIDincomparisontopatientsseeninCMpractice,withfewerNSAID-relatedadverseeventsandnolossoftherapeuticopportunity.

Canwetrustthisstudy?

This’EPI3study’ismanagedbyLA-SERaUKbasedcompanyspecialisedinscientificevidenceformedicineandhealthtechnologies(http://www.la-ser.com/).Theprojectteamincludesindividualsfromhigh-profileinstitutionssuchastheInstitutPasteurinParis,UniversityofBordeauxandMcGillUniversity,Montreal;LucienAbenhaimistheFrenchGeneralDirectorofHealth(SurgeonGeneral)[Wikipedia].References

1. NHSDigital:NHSPrescriptionCostAnalysis2016.Availablefrom http://content.digital.nhs.uk/catalogue/PUB23631/pres-cost-anal-eng-2016-rep.pdf [Accessed25Sept2017]

2. Freedom of Information Act request to the Department of Health by the Faculty of Homeopathy.Costwas£11.89millionbetween2005and2008.

3. BMJClinicalEvidence,EfficacyCategorisations.2017.Available fromhttp://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html [Accessed25Sept2017]

4. SpenceD,ThompsonEA,BarronSJ.Homeopathictreatmentforchronicdisease:a6- yearuniversity-hospitaloutpatientobservationalstudy.JAlternComplementMed 2005;5:793-7985. ThompsonE,ViksveenP,BarronS.Apatientreportedoutcomemeasurein homeopathicclinicalpracticeforlongtermconditions.Homeopathy,2016;105(4):3096. SharplesF,vanHaselenR,FisherP.NHSpatients'perspectiveoncomplementary medicine.ComplementTherMed2003;11:243-2487. Grimaldi-Bensouda,L.etal.Benchmarkingtheburdenof100diseases:resultsofa nationwiderepresentativesurveywithingeneralpractices.BMJOpen1,e000215 (2011)

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8. Grimaldi-Bensouda,L.etal.Managementofupperrespiratorytractinfectionsby differentmedicalpractices,includinghomeopathy,andconsumptionofantibioticsin primarycare:theEPI3cohortstudyinFrance2007-2008.PloSOne9,e89990(2014).9. Rossignol,M.etal.Impactofphysicianpreferencesforhomeopathicorconventional medicinesonpatientswithmusculoskeletaldisorders:resultsfromtheEPI3-MSD cohort.Pharmacoepidemiol.DrugSaf.21,1093–1101(2012)

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