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HO 27
Memorandum submitted by the Alliance of Registered Homeopaths (ARH)
1. Declaration of interests - 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: Ø raising public awareness of the potential of homeopathic treatment Ø encouraging a high standard of education for homeopaths Ø supporting the ongoing professional development of our members Ø encouraging co-operation between our members and other healthcare professionals, for the benefit of patients Ø engaging in research, publishing and other activities that enhance our understanding of homeopathy Ø acting as an information base for the general public
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 of homeopathy in the UK - 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 There are now just four homeopathic hospitals in the UK, and a number of Primary Care Trusts (PCT's) have withdrawn funding for homeopathy altogether, or will only refer a patient to one of the 400 GP's trained in homeopathy.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'. 4
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 1, and the other on cost efficiency 5. 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 - 2003.6 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 diseases.
7. Gathering evidence - There are three principal ways in which evidence is normally gathered: Ø the randomised, double blind, placebo controlled trial (RCT) Ø outcomes based evidence, which can either be clinically sourced, or patient generated in the form of a 'measure yourself medical outcome profile' (MYMOP) Ø 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 RCT's to represent a gold standard for determining the efficacy of a therapeutic intervention. However, RCT's 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 RCT's presents a significant challenge. However, a number of RCT's 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, 7 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 evidence - 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 1 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 2008,10 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, 15 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.
12. Empirical evidence - 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, 16 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.
14. Homeopathy and epidemics - 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 Influenza - A Chorus of Fifty in Harmony.17
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.18
16. Homeopathy and chronic disease - 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,19 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.
17. Homeopathy and animal health - 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,20 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
Bibliography
1 Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for chronic disease: a 6-year university-hospital outpatient observational study. Journal of Alternative and Complementary Medicine, 2005; 5: 793-798 2 Clover A. Patient benefit survey: Tunbridge Wells Homoeopathic Hospital. British Homeopathic Journal, 2000; 89: 68-72 3 Richardson WR. Patient benefit survey: Liverpool Regional Department of Homoeopathic Medicine. British Homeopathic Journal, 2001; 90: 158-162 4 HM Government, Department of Health. Our health, our care, our say: a new direction for community services. TSO, January 2006 5 Spence, DS. Cost-effectiveness of homeopathy in chronic diseases. Georg Thieme Verlag KG Stuttgart New York 6 Rossi E, Crudeli L, Endrizzi C, Garibaldi D. Cost-benefit evaluation of homeopathic versus conventional therapy in respiratory diseases. 2009 7 Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet, 1997; 350: 834-843 8 Linde K, Scholz M, Ramirez G, et al. Impact of study quality on outcome in placebo controlled trials of homeopathy. Journal of Clinical Epidemiology, 1999; 52: 631-636. 9 Ernst E. A systematic review of systematic reviews of homeopathy. British Journal of Clinical Pharmacology, 2002; 54: 577-582 10 Social & Market Research, in conjunction with the Norther Ireland Department of Health, Social Services and Public Safety. Evaluation, Complementary And Alternative Medicines Pilot Project. May 2008 11 Stevenson, H. Northern Ireland CAM Study - part one. Homeopathy in Practice (ARH), Autumn 2009; 24-33 12 Stevenson, H. Northern Ireland CAM Study - part two. Homeopathy in Practice (ARH), to be published Winter 2009 13 Hargreaves, N. Homeopathy for Substance Misuse. Alliance of Registered Homeopaths 2003 14 Hargreaves, N. Homeopathy for Substance Misuse. Homeopathy in Practice (ARH), January 2004, 10-15 15 Walters, C, Batty, J. North Kirklees PCT Homeopathy Service Pilot Project. Homeopathy in Practice (ARH), Autumn 2005, 18-20 16 Pittendrigh, A. The Handman. Homeopathy in Practice (ARH), Summer 2005, 49 17 Dewey, 18 Pinkus, T. Exciting research from 19 Ramakrishnan, AU, Coulter, C. A Homeopathic Approach to
Cancer. Quality Medical Publishing Inc., 20 Homeopathy in Practice (ARH), Summer 2009
November 2009
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