HOMEOPATHY WITHIN THE NATIONAL HEALTH SERVICE, UK How much is spent on homeopathy?€¦ · ·...
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Homeopathy in the National Health Service, UK, 2017 | Page 1 HOMEOPATHY WITHIN THE NATIONAL HEALTH SERVICE, UK Some people take the position that public money should not be spent on homeopathy because “there is no proof that it works” or “tax-payers money shouldn’t be spent on placebos”. However, very few people have access to the facts needed to weigh up this argument effectively, so below are some reliable facts on Homeopathy and the NHS. How much is spent on homeopathy? • In 2016, just £92,412 was spent on homeopathy prescriptions from a total expenditure of £9.2 billion. 1 • Out of the total NHS budget of £100 billion a year, £4 million (0.004%) is spent on Homeopathy 2 if you include everything from running the hospitals departments to paying the doctors. When considering value for money, it should be remembered that if homeopathy patients were not treated with this service, they would have to be treated by other departments using more expensive conventional drugs. Homeopathy should be considered in the same way as all other NHS treatments Some people argue that the NHS should not pay for homeopathy because we do not know that it works, whereas conventional medical drugs are ‘tried and tested’. Surprisingly this issue isn’t actually as clear-cut as one might think. Analysis by the British Medical Journal’s (BMJ) Clinical Evidence 3 shows that just 11% of 3,000 commonly used NHS treatments are known to be beneficial:
Transcript of HOMEOPATHY WITHIN THE NATIONAL HEALTH SERVICE, UK How much is spent on homeopathy?€¦ · ·...
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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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