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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 6-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 1100 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 2001-2006 (the study is in the final stages of preparation
for publication). The study looked at 2495 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 2 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 EA, Barron SJ. 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
WR. Patient benefit survey: Liverpool Regional
Department of Homoeopathic Medicine. Br Homeopath J 2001; 90: 158-162.
5 Reilly D, Mercer SW, Bikker AP, 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 WB, Lewith GT. The role of
outcomes research in evaluating complementary and alternative medicine. Altern
Ther Health Med 2002; 8: 88-95.
8 Spence DS, Thompson EA, Barron SJ (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 CM, Roll S, Vance W, Weber K, Wegscheider K, Willich SN (2008).
Homoeopathic versus conventional treatment of children with eczema: A
comparative cohort study. Complementary Therapies in Medicine, 16:15-21.
10
Bordet MF, 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 EA, Mathie RT, Baitson ES,
Barron SJ, Berkovitz SR, Brands M, Fisher P, Kirby TM, Leckridge RW, Mercer SW,
Nielsen HJ, Ratsey DHK, 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 SW, 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
AP, Mercer SW, 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
SW, Reilly D, Watt GC (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 WR.(2001) Patient benefit survey: Liverpool
Regional Department of Homeopathic medicine. British Homeopathic Journal 90 158-162.
Dr
Hugh Nielsen
Department
of Homeopathic Medicine
Old
Swan Health Centre
Liverpool(PCT)
November 2009
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