Memorandum submitted by Dr Hugh J Nielsen
(HO 29)
EVIDENCE FOR HOMEOPATHY IN THE NHS
1. SUMMARY
1.1 Each of the homeopathic hospitals on
the NHS reported clinical outcomes data from a wide range of medical
complaints. [1-5] At each hospital, positive outcomes has been
reported by about 70% of follow-up patients overall, pointing
out the value of homeopathy to patients and the need for further
research initiatives to investigate the positive effects of the
homeopathic intervention in particular diagnoses. [6,7]
2. BACKGROUND
2.1 The United Kingdom's homeopathic hospitals
are located in Bristol, Glasgow, Liverpool, and London. The four
have been part of the country's National Health Service (NHS)
since its inception in 1948, and are staffed by medically qualified
practitioners who possess additional training and certification
in homeopathy. All units have outpatient services only, except
Glasgow Homoeopathic Hospital (GHH), which has an additional in-patient
service.
3. HOMEOPATHIC
HOSPITALS OUTCOME
SURVEYS AND
OTHER STUDIES
3.1 An observational study at Bristol Homeopathic
Hospital included over 6,500 consecutive patients with over
23,000 attendances in a six-year period (Spence, Thompson
& Barron, 2005). [8] 70% of follow-up patients reported improved
health, 50% major improvement. The most common diagnostic groups
were Dermatology, Neurology, Rheumatology, Gastroenterology, Psychiatry
and Ear, Nose & Throat. The best treatment responses were
reported in childhood eczema or asthma, and in inflammatory bowel
disease, irritable bowel syndrome, menopausal problems and migraine.
The main weakness of this study was the crudeness of the outcome
measure; the strength of the work was in its size and comprehensiveness.
Further non-randomised research has corroborated such results
in childhood eczema (Keil et al., 2008) [9] and menopausal
syndrome (Bordet et al, 2008), [10] for example.
3.2 A 500-patient survey at the RLHH showed
that many patients were able to reduce or stop conventional medication
following homeopathic treatment (Sharples, van Haselen & Fisher,
2003). [11] The size of the effect varied between diagnoses: for
skin complaints, for example, 72% of patients reported being able
to stop or reduce their conventional medication. The study also
showed that many patients seek homeopathy because of their concerns
about the safety of conventional treatment.
3.3 In a pilot study published in 2008,
data from 1602 follow-up patient appointments at all five
NHS homeopathic hospitals were collected together over a one-month
period (Thompson et al, 2008). [12] Eczema, chronic fatigue
syndrome, menopausal disorder, osteoarthritis and depression were
the "top five" most referred conditions. The medical
problems referred to the hospitals typically are chronic conditions
where available conventional treatments are often not effective.
In total, the study identified 235 separate medical complaints
treated at the hospitals during one month. Many patients had multiple
pathologies. At just their second homeopathic appointment, 34%
of follow-up patients overall reported an improvement that affected
their daily living. For patients at their sixth appointment, the
corresponding improvement rate was 59%. The study showed that
reported health benefit may be gained more quickly in some medical
conditions than in others. The pilot findings are informing a
programme of standard setting for treatment outcomes in the NHS
homeopathic hospitals.
3.4 Qualitative research carried out at
GHH found that those motivated to seek this form of treatment
may achieve an empathy with their homeopathic doctor that can
make a positive contribution to the enablement and health change
they feel as a result of their appointments (Mercer, Reilly &
Watt, 2002; Bikker, Mercer & Reilly, 2005). [13,14] Patients
attributed key importance to the length of consultations, the
whole-person approach, being treated as an individual, and telling
and having their "story" listened to in depth (Mercer
& Reilly, 2004). [15]
3.5 An outcome survey carried out at the
Liverpool department of homeopathic medicine over a 12 month
period in 1999-2000 (Richardson, 2001) [16] 1,100 patients
were surveyed; 76.6% reported an improvement in their condition
since starting homeopathic treatment and 60.3% regarded their
improvement as major. 814 patients were taking conventional
treatment for their condition and 424[52%] of these were able
to reduce or stop conventional medication. The main conditions
treated were osteoarthritis, eczema, chronic fatigue syndrome,
asthma, anxiety, headaches, inflammatory arthritis and irritable
bowel syndrome.
3.6 A further outcome study was conducted
at the same department in Liverpool covering the period 2001-06 (the
study is in the final stages of preparation for publication).
The study looked at 2,495 patients of whom 72.9% reported
an improvement in their condition and 57.3% rated their improvement
as major. 1648 patients were taking conventional treatment
and 771[46.8%] of those were able to reduce or stop it. The main
conditions treated in this study were eczema, osteoarthritis,
chronic fatigue syndrome, menopausal symptoms, anxiety, asthma
and depression.
3.7 A patient satisfaction survey carried
out at the Liverpool department in November 2008 showed that
of 132 patients questioned, 115 were very satisfied
and 15 were satisfied with the service provided. 98 patients
said that they thought homeopathy was helping their condition,
27 were unsure and two said it wasn't helping.
4. RECOMMENDATIONS
4.1 Given the patient outcomes and satisfaction
it would be of immense benefit to the NHS and to patients to engage
in research in homeopathy and cost effectiveness of homeopathy
in the NHS.
4.2 The outcome studies demonstrate that
there are specific conditions where homeopathy is particularly
useful and is an important element in improving patients' lives.
REFERENCES
1. Sharples F, van Haselen R, Fisher P. NHS patients'
perspective on complementary medicine. Complement Ther Med 2003;
11: 243-248.
2. Spence D, Thompson E A, Barron S J. Homeopathic
treatment for chronic disease: a 6-year university-hospital outpatient
observational study. J Altern Complement Med 2005; 5: 793-798.
3. Clover A. Patient benefit survey: Tunbridge
Wells Homoeopathic Hospital. Br Homeopath J 2000; 89: 68-72.
4. Richardson W R. Patient benefit survey: Liverpool
Regional Department of Homoeopathic Medicine. Br Homeopath J 2001;
90: 158-162.
5. Reilly D, Mercer S W, Bikker A P, Harrison
T. Outcome related to impact on daily living: preliminary validation
of the ORIDL instrument. BMC Health Serv Res 2007; 7: 139.
6. White A, Ernst E. The case for uncontrolled
clinical trials: a starting point for the evidence base for CAM.
Complement Ther Med 2001; 9: 111-115.
7. Walach H, Jonas W B, Lewith G T. The role
of outcomes research in evaluating complementary and alternative
medicine. Altern Ther Health Med 2002; 8: 88-95.
8. Spence D S, Thompson E A, Barron S J (2005).
Homeopathic treatment for chronic disease: a 6-year university-hospital
outpatient observational study. Journal of Alternative and
Complementary Medicine, 11:793-798.
9. Keil T, Witt C M, Roll S, Vance W, Weber K,
Wegscheider K, Willich S N (2008). Homoeopathic versus conventional
treatment of children with eczema: A comparative cohort study.
Complementary Therapies in Medicine, 16:15-21.
10. Bordet M F, Colas A, Marijnen P, Masson J,
Trichard M (2008). Treating hot flushes in menopausal women with
homeopathic treatment—results of an observational study.
Homeopathy, 97:10-15.
11. Sharples F, van Haselen R, Fisher P (2003).
NHS patients' perspective on complementary medicine: a survey.
Complementary Therapies in Medicine, 11:243-248.
12. Thompson E A, Mathie R T, Baitson E S, Barron
S J, Berkovitz S R, Brands M, Fisher P, Kirby T M, Leckridge R
W, Mercer S W, Nielsen H J, Ratsey D H K, Reilly D, Roniger H,
Whitmarsh TE (2008). Towards standard setting for patient-reported
outcomes in the NHS homeopathic hospitals. Homeopathy,
97:114-121.
13. Mercer S W, Reilly D (2004). A qualitative
study of patient's views on the consultation at the Glasgow Homoeopathic
Hospital, an NHS integrative complementary and orthodox medical
care unit. Patient Education and Counselling, 53:13-18.
14. Bikker A P, Mercer S W, Reilly D (2005).
A pilot prospective study on the consultation and relational empathy,
patient enablement, and health changes over 12 months in
patients going to the Glasgow Homoeopathic Hospital. Journal
of Alternative and Complementary Medicine, 11:591-600.
15. Mercer S W, Reilly D, Watt G C (2002). The
importance of empathy in the enablement of patients attending
the Glasgow Homoeopathic Hospital. British Journal of General
Practice, 52:901-905.
16. Richardson W R.(2001) Patient benefit survey:
Liverpool Regional Department of Homeopathic medicine. British
Homeopathic Journal 90158-162.
Dr Hugh Nielsen
Department of Homeopathic Medicine
Old Swan Health Centre
Liverpool(PCT)
November 2009
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