Memorandum submitted by the Alliance of
Registered Homeopaths (ARH) (HO 27)
The Alliance of Registered Homeopaths (ARH)
is the second largest registering and regulatory body for the
homeopathy profession in the UK. ARH currently has nearly seven
hundred qualified homeopaths on its register, and just under four
hundred individuals belonging to other membership categories,
such as students and subscribers. ARH is set up as a Company Limited
by Guarantee, and is a not for profit organisation. We are committed
to supporting and promoting a high standard of safe, effective
homeopathic practice, and to ensure that quality homeopathy is
available to all who wish to use it. Other ARH functions include:
raising public awareness of the potential
of homeopathic treatment;
encouraging a high standard of education
supporting the ongoing professional development
of our members;
encouraging co-operation between our
members and other healthcare professionals, for the benefit of
engaging in research, publishing and
other activities that enhance our understanding of homeopathy;
acting as an information base for the
2. ARH has based our regulatory criteria
on the UK National Occupational Standards for Homeopathy (NOS),
and we were active participants in the recent revision of the
NOS's, as overseen by Skills for Health, earlier this year.
3. BRIEF OVERVIEW
It is estimated that there are well over 3,000 practising
homeopaths in the UK, of whom 2,500 are registered with a
professional body. Homeopathy is one of the most frequently sought
complementary therapies, with at least 20% of patients choosing
homeopathy as their treatment option each year. Access to homeopathic
treatment via the NHS is limited. There are now just four homeopathic
hospitals in the UK, and a number of Primary Care Trusts (PCTs)
have withdrawn funding for homeopathy altogether, or will only
refer a patient to one of the 400 GP's trained in homeopathy.
Patients who choose to consult with a registered homeopath, or
want to avoid long waiting lists, have to fund their own treatment.
Many patients seek homeopathic treatment because conventional
medicine has little to offer them, or they are suffering from
adverse reactions resulting from a conventional intervention.
Although homeopathy is often sought as a last resort when other
treatment options have failed, outcomes are consistently positive,
with an average of 70% of patients reporting an improvement of
their symptoms following treatment. [1,2,3]
4. Recently, there has been a campaign demanding
the withdrawal of funding for homeopathy via the NHS altogether,
on the grounds that homeopathy is nothing more than placebo. This
assertion by homeopathy's detractors represents a selective interpretation
of the growing evidence base that exists, which in reality shows
homeopathy to offer an effective, safe, and l cost healthcare
intervention. Furthermore, to withdraw homeopathy from NHS provision
would deny patients the right of choice, a fundamental component
of the concept of patient centred healthcare delivery, as outlined
in the Department of Health (DoH) White Paper "Our health,
our care, our say: a new direction for community services".
5. COST EFFECTIVENESS
There have been a number of studies that demonstrate
the cost effectiveness of homeopathy, but the constraints of time
and word allocation only allow for a brief mention of two relatively
recent examples. The Bristol Homeopathic Hospital conducted an
outcome survey of over 6,500 individual patients, spanning
6 years from 1997-2003, and representing over 23,000 consultations.
Two papers resulted from the analysis compiled by Dr David Spence
and his colleagues, one focusing on patient outcomes,  and
the other on cost efficiency.  Patients suffering from a broad
range of chronic conditions including asthma, rheumatoid arthritis,
depression, irritable bowel syndrome and chronic fatigue syndrome,
were treated with homeopathy. An average of 70% of the patients
surveyed experienced a significant improvement in their overall
health following homeopathic treatment, and this was delivered
at a fraction of the cost normally associated with providing conventional
interventions for a similar range of conditions.
6. A cost evaluation of the treatment of
respiratory disorders, was undertaken in the Campo di Marte Hospital,
Tuscany, Italy, from 1998-2003.  The cost of conventional drug
treatment given to a group of patients suffering from asthma and
recurring respiratory disorders, was monitored for one year prior
the introduction of homeopathic treatment, then compared to the
conventional drug costs incurred over a two year period, following
the introduction of homeopathic treatment. The analysis shows
a reduction in drug costs specific to respiratory disorders of
over 46%, and a reduction of general drug costs of over 42% in
the patient group given homeopathy. Overall patient wellbeing
also improved significantly, a fact which undoubtedly contributed
to the reduction in drug requirements. For the patient group suffering
from asthma specifically, conventional drug costs were reduced
by 71% during the first year of homeopathic treatment, compared
to the group receiving only conventional medication, whose drug
requirements resulted in a 12% increase in overall costs.
According to a recent news release from Asthma UK, dated 21 October
2009, the treatment of asthma in the UK costs an estimated £1 billion
per year. The Italian study shows a cost saving on conventional
drugs ranging from between 42% to 71% over a two year period.
This makes the long term implications for delivering effective,
cost efficient treatment of asthma with homeopathy, highly significant.
A different facet of the cost effectiveness of homeopathy will
be touched on later, in relation to the prevention of infectious
There are three principal ways in which evidence
is normally gathered:
the randomised, double blind, placebo
controlled trial (RCT);
outcomes based evidence, which can either
be clinically sourced, or patient generated in the form of a "measure
yourself medical outcome profile" (MYMOP); and
empirical evidence, which is data acquired
through direct observation, usually under controlled circumstances,
where results are reported according to previously agreed protocols.
There may be some overlap with outcomes based evidence.
8. THE RCT
RCT's were originally developed as an appraisal
tool, and were intended to support and augment evidence acquired
through other, more observation based means. A number of scientists
consider RCTs to represent a gold standard for determining the
efficacy of a therapeutic intervention. However, RCTs have several
inherent fundamental flaws. They are designed to support/enhance
a particular outcome. The results they produce can, either intentionally
or unintentionally, be interpreted to reflect the required outcomes.
RCT protocols are founded on a number of broad generalisations
and assumptions, making it difficult to take into account the
reactions of each individual participant. Because homeopathy is
a system of medicine in which individualisation is key to a successful
prescription, gathering evidence via RCTs presents a significant
challenge. However, a number of RCTs looking for quantitative
evidence to support the efficacy of homeopathy, have been undertaken.
In 1997, a meta analysis of data extracted from 89 clinical
trials was published in The Lancet,  and concluded that the
results showed the beneficial action of homeopathy could not be
attributed to the placebo affect alone. Two subsequent reviews,
analysing trials from the same data set, corroborated this conclusion,
[8,9] though less strikingly than the original systematic review.
This highlights a problem associated with meta analyses in general,
which is that the quality of the reviews under consideration determines
the usefulness of the information extracted via systematic analysis.
Another problem may arise when (as mentioned earlier) the researcher
selects the reviews to be analysed, via criteria likely to influence
the outcome. Undoubtedly there is a valuable place for the RCT
within scientific research, providing its limitations are fully
acknowledged when interpreting the resulting data.
9. OUTCOMES BASED
A number of outcomes based trials have provided
positive information relating to the efficacy of homeopathy as
a treatment option, and their scope is broad ranging. The Bristol
Homeopathic Hospital Survey  is one well documented example
already referenced. Another high profile study, this time considering
homeopathy alongside other CAM therapies, was run as a year long
pilot study in Northern Ireland, starting in February 2007. Its
primary purpose was to evaluate how CAM could be effectively utilised
in collaboration with conventional interventions provided by the
NHS. The full report was published in May 2008,  and the results
are very interesting. An in depth evaluation of the report entitled
Northern Ireland CAM Study, by Heidi Stevenson, [11,12]
concludes that the pilot was highly successful in achieving its
goal; a demonstration of how CAM modalities could be integrated
into the NHS, to the benefit of both patients and health care
providers alike. As an aside, it also produced significant information
giving credence to the efficacy of CAM modalities, with homeopathy
showing excellent results for the treatment of mental/emotional
problems. The study provides convincing evidence regarding the
efficacy of CAM provision, which highlights the need for further
research to be undertaken in this area. Given the severe financial
constraints currently faced by the NHS, and the additional burden
placed on already stretched NHS resources by an increasingly ageing
population, the question to consider is "how can the NHS
afford not to fully utilise CAM provision in the services it offers"?
10. A research project undertaken by Nigel
Hargreaves in 2003, in partnership with NORCAS, a charity offering
support to individuals with alcohol related problems, offered
homeopathy and counselling to clients over a six month period.
[13,14] Clients were given six in depth consultations with the
homeopath, and their treatment was supported by regular sessions
with their counsellor in between appointments. Outcomes where
measured using MYMOPS, combined with feedback provided by the
counsellors involved. Although the study was small, the results
were very encouraging. Participants who completed the course reported
that alcohol now affected their lives an average of 64% less than
before commencing treatment. An additional benefit from treatment
with homeopathy was a reduction averaging 68% in their use of
conventional medication, such as anti depressants, sleeping pills
and anti-psychotic drugs. This reduction would probably have increased
if the study could have been extended further, because a number
of drugs have a lengthy withdrawal period. Unfortunately lack
of funding did not allow for any follow ups to take place. However,
setting up and undertaking the study provided a useful foundation
upon which to build for future initiatives. The study, which ran
on a budget of just £5,000, also demonstrated that useful
research into homeopathy does not necessarily have to cost large
sums of money.
11. The North Kirklees PCT Homeopathy Service,
 was a small scale pilot project which took place from April
2001 until March 2003. Two registered homeopaths worked in
collaboration with a GP homeopath to offer a homeopathy service
to patients in the North Kirklees Primary Care Group. Initially,
patients participating in the study were offered six consultations
with a homeopath. 287 patients were referred for homeopathy
treatment, with the largest number suffering from anxiety and
depression, with the next most common complaint being "female"
problems. Again, MYMOPS were used to gather information. About
19% of patients did not complete the homeopathy course, but those
who participated to the end of the project gave overwhelmingly
positive feedback. 93% of participants said they would recommend
the service to their friends. GPs within the PCG were also asked
to provide feedback re the study, and although only just over
half of the GPs asked actually responded, 76% of respondees said
they wanted the service to continue, and 40% believed it should
be a priority for funding.
Empirical evidence represents the collective
experience of countless individuals. It is information gathered
primarily via observation over an extended period of time, which
is then recorded, collated and used to increase and further develop
knowledge within a particular field. Empiricism lies at the foundation
of most of the scientific knowledge we take for granted today.
Homeopathic literature is full of examples of the efficacy of
homeopathy. One spectacular example is chronicled in the ARH's
Journal, Homeopathy in Practice,  and describes an incident
which took place in Kenya in 2005. A man in a feverish condition,
and clearly in a great deal of pain, presented with a seriously
swollen hand. The flesh across the bridge of his hand had been
eaten away, and his fingers were in danger of falling off. Apparently
he had been "bitten" by something some two weeks earlier.
The homeopath prescribed for him, and took a photograph of the
patient's suppurating hand. The patient then left to return to
his remote village, somewhere in the bush. Some months later,
the patient returned. He just wanted to say "thank-you"
to the homeopath. His hand was back to normal, apart from a tiny
hole just below his third finger, which was still oozing a small
amount of pus. The homeopath gave him a new prescription and took
another photograph, after which the patient left for the long
trek home. The full case study, complete with photos, is included
with this submission as appendix one.
13. It is worth noting that there are homeopaths
all over the world, working in remote and sometimes hostile environments,
treating life threatening conditions on a daily basis. These are
places where homeopathy is the only healthcare option available.
These are circumstances where the efficacy of homeopathy is constantly
demonstrated, not in a laboratory, or as the result of a RCT purposely
constructed to prove some hypothesis, but where it matters most,
which is helping to relieve the suffering of countless human beings.
Extensive medical records exist, recording the
efficacy of homeopathy in the treatment of epidemics. For example,
homeopathy's success at treating the Spanish flu outbreak of 1918 is
well documented, especially in the US. The medical records of
hospitals across the country consistently show a mortality rate
of above 28% in sufferers treated allopathically, as opposed to
a mortality rate of just over 1% of those treated with homeopathy.
A more detailed account of homeopathy's efficacy in treating the
Spanish flu outbreak in the US, is documented in a report to the
Journal of the American Institute of Homeopathy, entitled "Homeopathy
in InfluenzaA Chorus of Fifty in Harmony". 
15. In 2008, a groundbreaking research study
was conducted in Cuba, where homeopathy was used to prevent an
outbreak of leptospirosis in 2.4 million people during the
hurricane season. The results of this remarkable experiment, yet
to be published in full, were first presented at a conference
in Havana in December 2008. The Finlay Institute, a Cuban based
research institute, responsible for the production of allopathic
vaccines, is also involved in the research and development of
homeopathic products. They were responsible for the manufacture
of a homeopathic Leptospira nosode, which was rapidly made
available to populations in the three areas most affected by the
hurricanes. The result was that following the intervention, a
dramatic decrease in mortality was observed, with confirmed cases
of Leptospirosis at lower levels than normally expected. Furthermore,
there were no fatalities in hospitalized cases. This compared
to several thousand confirmed cases of Leptospirosis in previous
years, including some fatalities, even in populations where the
allopathic vaccine had been used. Another remarkable feature of
this study was its cost efficiency. The Leptospirosis nosode programme
had been delivered at a total cost of around US$200,00, whereas
a "normal" vaccination programme, which would only be
delivered to the most "at risk" population, would be
expected to cost in the region of US$3,000,000. The implications
of these findings to third world countries, struggling to provide
effective health interventions at a price they can afford, are
massive. The Finlay Institute is planning to undertake a new study
on a similar scale, using a homeopathic nosode of the H1N1 swine
flu virus on large cohorts of the Cuban population. The results
should prove to be very interesting. An overview of the Leptospirosis
study is included with this submission, as appendix two. 
Homeopathy has a long history of bringing relief
and improved wellbeing to patients suffering from chronic diseases.
A number of Indian homeopaths have written extensively about their
experience of working with chronic diseases, and as many consultations
in India take place within the clinical setting of a hospital,
extensive records of medical diagnosis and response to treatment
exist, to substantiate claims of successful treatment. Dr AU Ramakrishnan
is well known within homeopathic circles, for his success in treating
cancer. His book, A Homeopathic Approach to Cancer, 
synthesis his experience of treating over 5,000 patients
suffering from cancer, and is generally regarded as an invaluable
reference source for homeopaths in practice worldwide.
Homeopathy can be of considerable benefit to
animal health. Animals are crucial to human existence, forming
an important part of the food chain Animal health and human health
are inextricably linked. It is harder to cite the placebo affect
when observing an animal's response to appropriate homeopathic
treatment. Critics often claim that restoration to health results
from the intention to heal the animal. This hypotheses doesn't
explain how mastitis in cattle for example, can be controlled
by placing drops of a selected remedy in the drinking water accessed
by the entire herd. Also, if an inappropriate remedy is prescribed,
the best intentions in the world will not achieve a curative result.
Homeopathy can be highly effective in the treatment of animals,
yet surprisingly there are only about 250 vets trained in
homeopathy in the UK, and of those, only a few treat farm animals.
This restricts the choices available to livestock farmers, which
can have particularly serious implications for organic farmers.
It potentially limits the availability of chemical/hormone free
meat available within the food chain, which in turn impacts upon
the health and wellbeing of humans. As a result, an increasing
number of livestock farmers are learning to use homeopathy themselves
to successfully treat straight forward, acute situations. ARH
has published a journal solely dedicated to exploring the potential
of homeopathy in animal health,  a copy of which is included
with this submission (will be posted separately) as appendix four.
18. IN CONCLUSION
This submission has been an attempt to demonstrate
the breadth and range of available evidence which shows homeopathy
to offer safe, effective healthcare. The set word limit and tight
time frame has precluded a more in depth submission. ARH would
like to ask the House of Commons Science and Technology Committee
to recommend that an investment of funding and resources is made,
in order to gather more evidence of homeopathy in practice, and
undertake new research. Every practising homeopath has a wealth
of valuable information contained within their case studies. The
establishment of simple protocols appropriate for undertaking
a clinical audit, combined with the provision of means to systematically
collate and analyse data, would be relatively inexpensive to oversee,
and would reveal a wealth of information to further enhance our
knowledge and understanding of homeopathy. Many ARH registered
practitioners would be more than willing to participate in evidence
gathering studies, provided they were offered basic guidance and
support. Currently, the annual NHS budget stands at around £110 billion,
and increasing patient demands are stretching available resources
to breaking point. The inclusion of homeopathy in health care
delivery could do much to enhance patient wellbeing, at the same
time as significantly reducing overall costs to the NHS.
Karin Mont, on behalf
of the Alliance of Registered Homeopaths
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