Homeopathy
In 2009, it was reported that patients would be able to spend NHS money on treatments like homeopathy and acupuncture as part of the controversial personal health budget scheme, according to new details released by the Department of Health. Other ‘non-traditional’ services patients can choose from include personal assistants, equipment, complementary therapies or transport. Dr Foster has written a full booklet on patient choice, offering their perspective, which you can read here if you wish.
NHS Lothian was soon thereafter, however, considering whether it should continue to pay for homeopathy services. Those against complain that it has no scientific backing and any positive results are due to the “placebo” effect. But homeopathy has ardent supporters who say it has helped them get better and insist it should be available on the NHS. NHS Lothian’s consultation is about homeopathy and not about herbal remedies. The health board spends £240,000 a year providing homeopathy services, which is 0.017% of its annual budget. It has launched a consultation on whether it should follow NHS Highland, which removed its funding 2010.
But is homeopathy nothing better than a placebo? It turns out , anyway, that most family doctors have given a placebo to at least one of their patients, according to a new survey. In a poll, 97% of 783 GPs admitted that they had recommended a sugar pill or a treatment with no established efficacy for the ailment their patient came in with. The PLOS One study authors say this may not be a bad thing – doctors are doing it to help, not to deceive patients. The Royal College of GPs has apparently said that there is a place for placebos in medicine. Consent to treatment is the principle that a person must give their permission before they receive any type of medical treatment. Consent is required from a patient regardless of the treatment, from blood test to organ donation. The principle of consent is an important part of medical ethics and the international human rights law. Risk communication is an integral part of shared decision-making in health care.
A general perception is that the medicinal claims of homeopathy are unsupported by the collective weight of modern scientific research – outside of the CAM community, scientists have long regarded homeopathy as a sham. No individual preparation has been unambiguously shown by research to be different from placebo. The methodological quality of the primary research was generally low, with such problems as weaknesses in study design and reporting, small sample size, and selection bias. Since better quality trials have become available, the evidence for efficacy of homeopathy preparations has diminished; the highest-quality trials indicate that the remedies themselves exert no intrinsic effect. A review conducted in 2010 of all the pertinent studies of “best evidence” produced by the Cochrane Collaboration concluded that “the most reliable evidence – that produced by Cochrane reviews – fails to demonstrate that homeopathic medicines have effects beyond placebo.
However, patient autonomy is pivotal. According to the General Medical Council’s “Seeking patients’ consent: the ethical considerations” (1989):
“6. When providing information you must do your best to find out about patients’ individual needs and priorities. For example, patients’ beliefs, culture, occupation or other factors may have a bearing on the information they need in order to reach a decision. You should not make assumptions about patients’ views, but discuss these matters with them, and ask them whether they have any concerns about the treatment or the risks it may involve. You should provide patients with appropriate information, which should include an explanation of any risks to which they may attach particular significance. Ask patients whether they have understood the information and whether they would like more before making a decision.”
In October 2012, Jeremy Hunt promised to be “guided by science”:
Health Secretary Jeremy Hunt has promised to follow scientific advice in the decisions he makes. Mr Hunt was only appointed last month, but has already sparked controversy by saying he favours halving the abortion time limit to 12 weeks. He is also known to be a supporter of homeopathy, despite many experts doubting its effectiveness. Speaking on BBC Radio 4’s Today programme his decisions would be “evidence-based”. But he declined to say whether he believed there was any scientific evidence to support his personal opinions.
Interesting Evan Davis (@EvanHD) this morning on BBC Radio 4’s “Today” programme asked about what the “Hippocratic Oath”, which governs the professional conduct of medical Doctors (as well as the GMC’s “Good Medical Practice”) in this jurisdiction, says about it all. The answer is all to do with “primum non nocere”, as explained here in this paper from Smith 2005:
“The so-called Hippocratic injunction to do no harm has been an axiom central to clinical pharmacology and to the education of medical and graduate students. With the recent reexamination of the nature and magnitude of adverse reactions to drugs, the purposes of this research and review were to discover the origin of this unique Latin expression. It has been reported that the author was neither Hippocrates nor Galen. Searches of writings back to the Middle Ages have uncovered the appearance of the axiom as expressed in English, coupled with its unique Latin, in 1860, with attribution to the English physician, Thomas Sydenham. Commonly used in the late 1800s into the early decades of the 1900s, it was nearly exclusively transmitted orally; it rarely appeared in print in the early 20th century. Its applicability and limitations as a guide to the ethical practice of medicine and pharmacological research are discussed. Despite insufficiencies, it remains a potent reminder that every medical and pharmacological decision carries the potential for harm.”
This discussion about placebos is yet another example of where health policy meets professional ethics and regulation head-on, and where there is no absolute answer as yet.
