Memorandum submitted by Dr Hugh J Nielsen HO 29
Evidence for Homeopathy in the NHS
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
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.
outcome survey carried out at the
3.6 A further
outcome study was conducted at the same department in
patient satisfaction survey carried out at the
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.
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:
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
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
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
SW, Reilly D, Watt GC (2002). The importance of empathy in the enablement of
patients attending the
Dr Hugh Nielsen
Department of Homeopathic Medicine
Old Swan Health Centre