Homeopathy and the NHS debate
29 March 2017 Parliamentary Proceedings
David Tredinnick (Bosworth) (Con)
AN INSIGHT INTO the 'Good Thinking Society',
from the UK Parliament
David Tredinnick (Bosworth) (Con)
I beg to move,
That this House has considered homeopathy and the NHS. Mr Hanson, it is always a pleasure to serve under your chairmanship, particularly when before we have even started the match, you have given us extra time. It is not often that we are able to start a debate earlier than expected.
This debate has come about for two reasons.
The first is the attacks on the long-established national health service homeopathic service. Secondly, we are approaching a very happy moment, Homeopathy Awareness Week, when the homeopathic community comes together to tell people about what it can offer in providing support to doctors and alternatives where other treatments have not worked.
Homeopathy Awareness Week takes place from 10 to 16 April in a celebration of homeopathy: a safe, gentle, natural system of medicine that I have used for 30 years to great effect. In the UK, it might surprise people to hear that 15% of our population already use homeopathy and a further 80% have heard about it.
In the UK 15% of our population,
already use homeopathy
Many people are not sure what makes it different from other medical systems. The week aims to get people to have a better understanding. A lot of events have been organised, including the film première of “Just One Drop”.
To put things in a global perspective, some 450 million people use homeopathy each year. If homeopathy did not work, why would so many people choose to use it and carry on using it?
It is a global medical system, the second largest medical system in the world, and is used particularly in very poor communities, which I will come on to.On British practitioners, a survey recently showed that 72% of homeopathic patients rated their practitioners either very good or excellent. The 4Homeopathy group recent study showed that practitioners are treating all kinds of things, from irritable bowel syndrome—30%—to depression—20%.
More than three quarters of teenagers and 41% of adults receive homeopathic treatments for skin disorders. About a third of adults and 40% of teenagers go to homeopaths for anxiety and stress. It is a service that delivers both in and out.
Some 450 million, people (globally) use homeopathy each year
Mr Andrew Smith (Oxford East) (Lab)
I congratulate the hon. Gentleman on securing this debate. I certainly would not dispute the testimony of those who have benefited from homeopathic treatment, but does he not agree that scientific evidence of its effectiveness would help in a decision on whether to use it?
The right hon. Gentleman, who has been in the House as long as I have, has made a good point. There is scientific evidence out there, although we could use more. One of the problems is that, when scientific evidence is produced, it is pooh-poohed. However, that does not stop people using, for example, arnica cream when they get wounds.
It is a standard preparation and it is a homeopathic medicine. So there is a degree of need for more studies, but there are studies out there that are ignored.
I have said homeopathy is the second biggest medical system in the world. Some would say it is the most prestigious. It has always been held in very high regard by people who are widely respected. It is no secret that the royal family and many celebrities have used homeopathic medicine over the years. It has become increasingly important in an age when drug dependency is epidemic and when there are serious worries about the effectiveness of antibiotics.
The homeopathic private sector is growing fast not only in this country, Europe and America, but everywhere. However, in the NHS, we are under attack from people in the medical establishment. This goes back to 2005, when a letter was put out attacking homeopathic services in the health service. It was actually a bogus letter on NHS letterhead. The Countess of Mar and Lord Palmer asked a question about it and the reply acknowledged that“this document was not issued with the knowledge or approval of the Department of Health and that the use of the National Health Service logo was inappropriate in this instance. The document does not represent any central policy on the commissioning of homoeopathy”.
Anti-homeopathy groups such as the so-called Good Thinking Society, which is a front for one individual, a sceptic called Simon Singh, are threatening clinical commissioning groups with legal action for commissioning homeopathy. People such as Simon Singh are anti-patient, anti-choice and closed-minded individuals who have never studied or used homeopathy.
In the UK, we have a robust system of homeopathic regulation. We have the Faculty of Homeopathy, which was formed in the 1950s for doctors. Doctors are, of course, regulated by the General Medical Council as well. In 2015, the Professional Standards Authority took on oversight of the regulation of the 2,000 members of the Society of Homeopaths. Such enhanced regulation is important and is a good reason why homeopathy should be more greatly available in the health service.
Jim Shannon (Strangford) (DUP)
It is always good to have debates on anything to do with health, but particularly with homeopathy.
There have been several reviews of the scientific evidence on the effectiveness of homeopathy.
Indeed, this House had a report in 2010, which the Minister will be aware of, from the Science and Technology Committee. In my constituency of Strangford is a major shop in Newtownards that deals in nothing else but homeopathic medicine, which clearly shows a demand. Does the hon. Gentleman feel it is perhaps now time for the Government to look at homeopathy in a new light because of the demand that there is, and also to see what homeopathy can offer?
My hon. Friend makes a powerful point. There is insanity about this subject. The amount of money spent on homeopathic prescriptions in the health service is about £110,000 per annum
So why are those against it
so fanatically against it?
What is it that gives them the swivel-eyed look? Why do they take so much trouble to rub out an alternative at a time when the mantra of the Government is patient choice? It is quite bemusing.
Many of the patients that go to homeopaths have contraindications to pharmaceutical drugs, or chronic illnesses that have not been helped by conventional medicines. I say to the Minister that there are no cost savings to be made by banning homeopathic prescriptions, as patients will still need other interventions instead.
The Government should assess how much money the health service has spent on other interventions for these patients before the successful use of homeopathic medicine.If we look around the world, we see a much more developed landscape.
“In France, 70% of pregnant women use homeopathy.”
You can go to any chemist in France and find homeopathic preparations and chemists who are qualified to talk about them. If we go further afield, I particularly like the example of India where there is a Ministry for complementary medicine called the Ministry of AYUSH—the “H” in AYUSH stands for homeopathic medicine. I will say a little about that later.
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We have already discussed evidence and there is always a need for good studies. There was a study in France, which I sent to the Secretary of State a long time ago for consideration by the chief medical officer. I have not had a reply yet, although I accosted him about it in the Division Lobby this week. A bullet-proof study named EPI3, which looks at the integration of homeopathy into general practice in France, showed positive outcomes, as does a randomised double-blind, double-dummy, multi-centre, non-inferiority clinical trial, which covers everything possible to follow the protocol, looking at the effect of an echinacea-based hot drink versus oseltamivir in influenza treatment.
There are also promising indications that homeopathy could be helpful in combating the increasing problem of antimicrobial resistance. That is an example of a good study. I will come back to the EPI3 study.
The attacks on homoeopathy in the NHS come pretty much from one person. They come from an organisation called the Good Thinking Society, a charity that is not supposed to campaign for changes in the health service, but its website states that it wants to raise money because it “Helps us campaign against the funding of homeopathy”.
According to the website, its leader, the Good Thinking Society’s chairman, largely funds the whole operation and another charity. It launched an attack on the Liverpool homeopathic service to shut it down, and eventually it was shut down. It worked like this. There was a consultation for local people at the end of 2015, at which I had a representative. Some 90% of those present were in favour of retaining or extending the service. Voting was by secret ballot, using hand-held remote controls, and 90% were in favour. One lady present, who suffered from a range of chronic conditions that conventional medicine had been unable to treat, was close to tears. She said that the only thing that had allowed her to live a relatively normal life was homeopathy. She pleaded with the clinical commissioning group not to cut the homeopathy service.The next stage was a formal consultation open to everybody, with no restriction by area and no checking of who was contributing. That consultation found 73% against keeping the homeopathic service. It is my belief that that consultation was hijacked by the Good Thinking Society—that it got people to call in and distort the result. The right hon. Member for Oxford East (Mr Andrew Smith) and I have been here for a long time—nearly 30 years—and I think we can smell electoral fraud when we feel it. I cannot see how the results can go from 90% in favour to 73% against.
Patients who relied on that service have nowhere to go now, except for being a charge on the health service. That decision caused immense pain. One patient, Mr T, aged 58 from Liverpool, said in an interview from October 2015:
“After 3 years of trying everything my doctor gave me homeopathy, and within 4 months my stomach problems were better. 18 months later I can lead a normal life again.”
A London patient with arthritis said:
“It is the only thing that has helped me find remission from a disease that previously left me wheelchair-bound.”
The core of this debate is the most recent, and most serious, attack on NHS homeopathy—the attack on the Royal London Hospital for Integrated Medicine, the largest public sector provider of integrated medicine in Europe, formerly known as the Royal London Homeopathic Hospital. It offers an innovative patient-centred service, integrating the best of conventional and complementary treatments for a wide range of conditions. All clinics are led by consultants, doctors and other registered healthcare professionals, who received additional training in complementary medicine. This is a flagship hospital that is admired around the world. Instead of threatening it with closure, it should be hailed as an example of best practice and used to develop integrated medicine and to spread understanding of its benefits to the public and the health community.For greater accuracy, I spoke to the director, Peter Fisher, and I have a briefing note from him. Apart from being a director of the hospital, he happens to be—as he described himself when he came before the Select Committee on Health in the last Parliament, during an inquiry into long-term care and conditions when I was acting Chair of the Committee—physician to Her Majesty the Queen. This is not somebody with a little training; he is a highly proficient, highly trained doctor—so much so that he is a doctor at that level.Dr Fisher says:
“The Good Thinking Society is harassing the Royal London Hospital for Integrated Medicine by threatening legal action against its host clinical commissioning group, Camden. The RLHIM has an agreement with the north London cluster of clinical commissioning groups, led by Camden, for clinical care pathways for 13 conditions. Patients who do not have these conditions can be treated if normal treatments have failed or have caused serious adverse effects, and in certain other circumstances. The GTS is attempting to close the latter pathway. This would cripple the hospital, preventing it from providing homeopathy, herbal and other treatments and from treating cancer patients. The GTS has harassed the RLHIM and other complementary medicine providers with legal action, reporting to the ASA”—the Advertising Standards Authority—“and the Charity Commission.”
I will say more on that if we have time. He continues:
“The RLHIM is the largest public sector centre for integrated medicine in Europe with a strong record of provision, innovation and research. A large scale study in France comparing conventional and homeopathic GPs showed that homeopathic GPs prescribe far fewer drugs, with the same or better clinical results, at 20% less cost.”
So there is an economic argument here, which I will say a word about in a moment.
In the year ending March 2016, the Good Thinking Society had an income of about £100,000. It gave £25,000 to something called the Nightingale Collaboration, which is not a charity, so that it could use the money more freely. That organisation has attacked osteopaths, who are regulated by an Act of Parliament—I was on the Bill Committee for that—and homeopaths, and has waged a campaign against complementary therapies with the Advertising Standards Authority.
The individual, Simon Singh, is a strange and inconsistent individual. He sent me an email before Christmas explaining why he could not send me a Christmas card. I am not sure I would have expected one, as I absolutely despise him. In 2015, it was reported that the charity made claims that processed sugars are not deadly and do not feed cancer, but he did not reveal that the charity was receiving funds from a very large soft drinks manufacturer. I think it is accepted that large amounts of sugar are not necessarily a good diet for cancer patients. I think that is why he got his nickname, “Sugar Drinks Simon”.Mr Singh also criticised the lyrics of the Katie Melua song “Nine Million Bicycles” for inaccuracy, referring to the size of the observable universe. He proposed correcting the lyrics, saying that the value of 13.7 billion light years would be correct. I looked into that and found that the correct figure is 46.5 billion light years from home. Even on that subject, on which Mr Singh professes to have knowledge, he was wrong—so there is no surprise that he is wrong about homeopathy, about which he has absolutely no knowledge.
To recap, we have what my daughter would call the absolutely bonkers situation where an individual, Singh, who is a physicist, not a physician, with no understanding or experience of homeopathy, is trying to cripple our leading academic medical centre, part of the University College London Hospitals NHS Foundation Trust, whose director—the man running it—is the Queen’s doctor. How mad can you get?
The core problem is not about whether or not homeopathy is effective. There have long been arguments about evidence-based medicine. Professor Sackett, who was responsible for the phrase, did not say it is about whether medicines work or not. He said it is about integrating individual clinical experience and the best external evidence; it is not just about external evidence. It is not just about the medicine—it is about the patient’s and the clinician’s experience. The nub of it is that complementary medicine can reduce the costs on the health service.
I have quoted the French EPI3 study, which said that French GPs who integrate homeopathy in their practice use about a third of the antibiotics and psychotropic drugs and half the analgesics, with very similar results, at 20% less cost. That is not taking into account antimicrobial resistance or the adverse effects of analgesics, sleeping tablets or whatever.There is a turf war here between two sides of the medical establishment, which is actually about resources. We have to resist that. The Secretary of State said, very sensibly, on LBC on 10 September 2014:
“There are some bits of the NHS where it”—homeopathy—“is sanctioned by GPs, but it wouldn’t be done without a doctor saying they thought that that was the right thing to do. And what doctors say is the right thing.”
He signed early-day motion 1240, which was about supporting homeopathic hospitals, in the 2006-07 Session of Parliament. It was signed by more than 200 Members—nearly a third of the Members of the House of Commons.
Today of all days—Brexit day—when the Prime Minister will be writing to the European Commission, I found this written answer in the Scottish Parliament from 23 February 2011. The then Health spokesman—no less an individual than the current First Minister, Nicola Sturgeon—replied. This is what she said in reply to a question about the effectiveness of homeopathy in relation to the Scottish Government’s integrative approach to patient care:
“In primary care, costs will relate to the cost of the remedy, which can be cheaper than the cost of orthodox drugs. Practitioners have also noted a reduction in side effects and dependency risks in some cases. In secondary care in Scotland, homoeopathy is only employed within a broader integrative care approach, with surveys showing both enhanced wellbeing and symptom reduction across a broad range of long term conditions, and a resultant reduction in NHS costs through reduced GP and hospital visits and repeat prescriptions.”
Well, there we are. That is what the First Minister in the devolved Administration thinks.Homeopathy is a wonderful system of medicine. It has been part of the national health service for a long time, and I look forward to hearing from the Minister about the Government’s position. 11.21 am
The Parliamentary Under-Secretary of State for Health (David Mowat)
It is a pleasure to serve under your chairmanship, Mr Hanson. I congratulate my hon. Friend the Member for Bosworth (David Tredinnick) on yet again leading the charge—we have debated this issue in various parts of Parliament—and on securing this debate in close proximity to Homeopathy Awareness Week, which starts on 10 April. He normally corresponds with my colleague, the Minister for Public Health and Innovation. I apologise that he has to put up with me today, but I will do my best to address the points he raised and set out as specifically as possible the Government’s and the NHS’s position on homeopathic remedies.
The Government have no particular position on the efficacy or not of any type of treatment, but we have a position on evidence-based medicine, and I will come on to talk about how we expect an evidence base to determine how we spend public money.
There is an acceptance that there is great popularity for some parts of this medicine across the world, as my hon. Friend said.
The Government have no particular control over how people spend their money in terms of these treatments. He was involved in the Walker report and review, which put in place a regulatory environment involving the Professional Standards Authority system and the voluntary lists for that.
As well as that popularity-led issue, there is the issue of how we spend public money in the NHS. I will come on to that process, but it is about the evidence base. It is right that there is a method of evaluating competing drugs, technologies and treatments. I will come on to talk about that and what it means in this context. We have no overall position on this issue. My hon. Friend made a good point about the over-prescription of antibiotics. He said that, in certain areas, homeopathic remedies may be an alternative.
I used the phrase “evidence-based medicine”, which means that the medicine is clinically cost-effective. Typically, the drugs that are used across the NHS are subject to trials—possibly lasting many, many years and involving large populations, statistically clear correlation and all that goes with it. A requirement of those drug trials is that their results are not anecdotal, but clearly repeatable. The drugs must demonstrate efficacy. When the National Institute for Health and Care Excellence evaluates them, it uses a threshold to measure their cost versus the quality of life and the years that are obtained by their use. Precisely the same criteria would be applied to any homeopathic or alternative remedy; they would be evaluated in that way. The Department’s position is that medicine must be evidence-based. Within that constraint, we use what the evidence tells us to use. For non-NHS expenditure, it is up to the public to buy what they wish, provided it is safe. There are some controls, and if I have time I will talk a little about the Walker review and what the controls are.
The NHS’s commissioning power is set locally by CCGs, which are GP-led. They set out their policies, in terms of what the CCG uses, but as they do that we expect them to be advised and informed by best practice and, where they are available, by NICE guidelines. Within that, GPs have considerable discretion. As my hon. Friend knows, some GPs still prescribe such remedies, where that is permitted by the CCG. That is not something that the Government have chosen to interfere with, although the drive towards evidence-based medicine means that over the past decade the amount of prescribing has decreased considerably. Last year, something like 9,000 separate prescriptions were made in primary medicine at a cost of about £100,000. A decade ago, the figure was nearer £150,000. That decline has been driven not by a Government diktat, but by our requirement that all CCGs use an evidence base for their decisions.My hon. Friend gave various views about the evidence base. In 2010, the House of Lords Science and Technology Committee said:
“There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious.”
More recently, NICE said that it is not aware of any evidence that demonstrates therapeutic effectiveness, and it does not currently recommend that homeopathy should be used as a treatment for any health condition. As a consequence, there has been a tail-off in the use of such remedies.I accept that, in certain circumstances, patients may feel that they have tried many other things, and a physician working with them might say, “Let’s have a go at one of these things. What have we got to lose?” As I say, it is not the Government’s job to stop a GP taking that position in that situation. Very often, that will be done in conjunction with a patient who, as my hon. Friend said, feels as though they have tried everything else, and will have a go at it as a last resort. It may well be that, anecdotally, it works, whether that is through a placebo effect or for whatever other reason. It is not the Government’s job to stop that.In the last minute that I have, I want to talk about the Walker review, of which I think my hon. Friend was the vice-chairman—he certainly helped to inform it. A system of regulation was brought in. We have been talking about the potential need for statutory regulation of the use of such remedies outside the health service. The Walker review looked at a variety of issues with respect to such medicines and concluded that we should put in place a voluntary system of regulation accredited by the PSA—something of a middle way.
The Society of Homeopaths is now regulated by the Professional Standards Authority, and will be looking to the health service to make better use of its services.
The Society of Homeopaths is accredited by the PSA, as my hon. Friend says. When somebody gets accredited, that is an endorsement that that practitioner is committed to safety and to work of good practice. It is not necessarily an endorsement of the technique that is being used, but it is accreditation that it is a safe technique. We accept that, and we would like more professionals working in that area to go down that route. I will finish on that note. I hope that I have been successful in setting out the Government’s position.
Motion lapsed (Standing Order No. 10(6)).
11.30 am Sitting suspended.
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