Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 520-539


21 FEBRUARY 2007

  Q520  Lord Taverne: A Lancet paper recently compared 110 homeopathy trials with 110 conventional medicine trials and found there was no evidence whatsoever that homeopathy performed better than placebos.

  Ms Chatfield: The conclusions the authors came to were based on eight trials of homeopathy, not 110. What they did was single out what they called the high quality homeopathy trials and narrowed them down to eight trials of homeopathy, none of which were reflective of homeopathy as it practised in the real world. These trials involved a combination of isopathy, and therapeutic prescribing, not individualised homeopathy. It was unbelievable that they could draw that conclusion from eight trials that homeopaths would not even consider homeopathy.[2]

  Professor Ernst: Unbelievable or not, the importance of this Lancet paper that you quote lies not in that it may be the only paper questioning the efficacy of homeopathy. There are to my knowledge well over a dozen such systematic reviews published in the peer reviewed literature which all show the same thing, so the importance lies in yet another confirmation of something that has been shown a dozen times before.

  Professor Brostoff: The fact that there may be a meta analysis showing that many trials are negative does not negate, for example, three positive trials that David O'Reilley did in the homeopathic hospital in Glasgow. The fact that you have lots of negatives does not deny a positive.

  Professor Corrigan: On a statistical basis, one would expect one trial in 10 to be positive purely at random.

  Ms Chatfield: A major problem with meta analyses and homeopathy is that they incorporate lots of different kinds of prescribing and it would be prescribing for the whole person, prescribing for the disease, using isopathy, comparing them all, lumping them all in together as if they are one thing when they are not. We do know that some of the older trials of homeopathy were not robust in terms of the way that they were designed and carried out.[3]

  Q521Lord Colwyn: I am sure the panel would agree that, despite the criticism, there is no doubt that these techniques—we can go back to kinesiology and Vega testing and also homeopathy—have successes. I have referred patients to a kinesiologist for 30 years and I do not think he has ever got one wrong.

  Professor Corrigan: I am afraid that is the sort of anecdotal report we have to be very careful of. Such observations mean nothing outside a properly controlled trial. Anybody can convince themselves they have benefited, particularly the person who recommended them, but I am afraid that does not constitute scientific evidence.

  Q522  Lord Colwyn: It constitutes a grateful patient usually.

  Professor Corrigan: We are all in the business of making patients happy. If that is all we are doing, maybe there is room for that but if we are talking about real science that is a different matter.

  Q523  Lord Broers: Professor Corrigan, would you agree that homeopathy at least does not suffer from the dangers of herbalism in that if there are toxins they are diluted beyond action?

  Professor Corrigan: Yes, absolutely. It is hard to see how they would be toxic but I do not agree that they are necessarily harmless because they may delay accurate, valid and pressing diagnosis.

  Q524  Baroness Platt of Writtle: There is some concern that seeking help from complementary medical practitioners may delay the diagnosis of allergic diseases by more evidence based therapies or even lead to misdiagnosis, which could have potentially fatal consequences. How would you respond to this suggestion?

  Ms Chatfield: In homeopathy we do not pretend to diagnose in the way that conventional medics do. Most of the patients that come to see us have already tried everything else. Then they try homeopathy. It is a last resort kind of treatment for most people. We also have a strict code of ethics and practice which our practitioners are bound by and within our code of ethics and practice practitioners are told that they should always point out to their patients the necessity to visit a GP. We have never had a complaint of that nature in the 29 years of the Society of Homeopaths being in existence.

  Professor Brostoff: The fact that allergy is taught at a remarkably low level in medical school, the fact that there are probably under five trainees in allergy for the whole of the United Kingdom and the fact that several allergy clinics have now been shut means that patients are not getting a fair crack of the whip in standard allergy clinics. To take the questioners point, I have seen patients who have been to two or three allergy clinics where a very important and significant medical condition has been missed, potentially fatal in one case, but the boot is sometimes on the other foot. If we train enough allergists of a high quality, I do not think this question would be worth considering, but sadly we do not.

  Q525  Baroness Perry of Southwark: My question is about the standard of proof that the Medicines and Healthcare Products Regulatory Agency uses. As you will all well know, it registered its first herbal medicine last November and, as I understand it, a herbal medicine gets onto the register only if its maker can prove that the substance has been used in traditional medicine for many years. They do not have to prove that it is efficacious. Do you think this is an appropriate standard of proof or should complementary medicines have to prove their efficacy to the same extent as more conventional medicines?

  Professor Corrigan: I am afraid this is appalling nonsense. We have been campaigning as allergists to get allergen immunotherapy licensed by the MHRA for years. This is a very scientifically validated treatment which is of great benefit to thousands of sufferers with hay fever and still the MHRA turned us down because some patients have reactions to the injections. It is very frustrating that they then condone the use of these untried, uncharacterised and untested concoctions on the basis of no evidence at all. It is completely impossible to understand and very frustrating for the practise of proper, scientifically conducted allergy.

  Ms Chatfield: Of course, I do not think it should be taken in isolation as a form of evidence but it is still a kind of evidence.[4] I think the Chinese would be horrified by what you have just said, that because their medicine has not been scientifically proven it should not be used.

  Professor Ernst: I agree with Professor Corrigan. It is a nonsense and it is very regrettable because it sets a double standard for the first time in medicine regulation and, for me as a researcher, it is particularly detrimental because it just puts any impetus to do any further efficacy research down to the level of zero. We are freezing our knowledge of potentially beneficial herbal treatments if we do not ask for proof of efficacy.

  Q526  Baroness Platt of Writtle: Professor Ernst, you did say earlier that private practitioners clearly are not concerned with funding research into the efficacy of what they do, but is there a need for real research into efficacy and are there any charities or other bodies that are funding research of this kind?

  Professor Ernst: Research funding is the most difficult thing in my life to obtain. It is nearly impossible and it has become even more impossible over the last few years because regulation of clinical trials is now such that it is very expensive, mostly geared up to large pharmaceutical trials, and to conduct a trial of homeopathy or herbal medicine under these circumstances would be very difficult indeed. Public funds are by and large not available. The science select committee seven years ago recommended large funds to be made available. That has not happened. Industry funds are non-existent so we are reliant on charitable funds which are very scarce indeed.

  Q527  Lord Colwyn: It has been about 10 years since I visited you in Exeter. What is your level of research staff at the moment? Do you have a number of DHS fellowships and PhDs there?

  Professor Ernst: We have about 10 research staff in Exeter which makes us by far the largest unit of that nature in Great Britain. We have no government funding at all. We did not get any despite various attempts. Basically, we live on charitable funds, the most important of which is the Laing Foundation.

  Q528  Chairman: How many prospective comparative studies do you have under way at the moment?

  Professor Ernst: Zero. It is not out of ambition; that is my expertise and I cannot fund them any more so we have shifted our emphasis towards meta analysis of clinical trials, not because we particularly think they are important. We think they are important but clinical trials would be more important. It is simply by default.

  Q529  Chairman: I wonder if you could explain to us the difference between immunotherapy and enzyme potentiated desensitisation and any dangers of adverse reactions with either?

  Professor Brostoff: Classic immunotherapy as practised in the NHS and in the UK is incremental immunotherapy. That is, for the most part, it starts at a low dose and builds up. It is allergen specific based on skin testing and serology. Many studies are done on that. We did the first study of sublingual immunotherapy which is a little more comfortable for the patient and that has now been accepted by the European Academy of Allergy as a validated treatment for inhalant allergy—that is, hay fever and sometimes asthma. There are other variations on this form of immunotherapy using titrated doses. EPD is enzyme potentiated desensitisation which contains enzymes and a low level of allergen. This has been used for almost 40 years. It has had one study published in the BMJ on hay fever which showed no difference between active and placebo. I understand there were significant problems with that study. Anecdotally, the side effects are minimal and anecdotally many patients respond well to it.

  Q530  Lord Haskel: If we could move on to the provision of complementary and alternative medicines, some seven years ago this Committee produced a report and one of the proposals was that they should introduce statutory regulation for practitioners of herbal medicine and acupuncture. The government decided to act on this in 2005. What progress has been made towards implementing these proposals?

  Professor Corrigan: I am afraid I cannot answer in a professional sense but you only have to walk down the high street to see that there is a great deal of deregulation still in existence. So far as I am aware, any practitioner can put up a brass plate and sell herbal medicines. Is that not the case? Certainly you can walk into any high street shop and have a Vega test. I do not see any regulation at all as a lay person and a consumer. I cannot answer you professionally because I am not involved in the licensing of alternative practices.

  Professor Ernst: I am also not involved in these regulatory issues but I know that chiropractors and osteopaths are regulated, as we all know, and acupuncturists and herbalists are well on the way to being regulated as professionals. I believe there is an initiative to bring all the other complementary therapies under one regulatory umbrella. How far this has succeeded or advanced I am not aware of but I think a regulatory process is well on its way. I am not sure that this is entirely a good thing because, as I pointed out, if you regulate traditional herbalists and there is no shred of positive evidence for their individualised approach, you regulate in my view nonsense and that will result in nonsense.

  Ms Chatfield: I would like to reiterate what Professor Ernst has said. My understanding is that they are well on the way to regulation. They are in the last stages. There have been many things that they have had to sort out about who would be allowed to go on the register in terms of the qualifications and kind of practice they have, how they practise. They are managing at the moment to sort all those out and move on.

  Q531  Lord Haskel: The Committee was quite impressed with the regulation of the osteopaths and chiropractors and also with the work that they did for continuing professional development. Is there any guidance for the general public to help them choose a reputable practitioner and how could this be improved?

  Ms Chatfield: Certainly I think regulation is the way to go and in homeopathy we would like to go for statutory regulation ultimately ourselves. At the moment, we are in the process of voluntary regulation and putting together one register for all the homeopathy professionals. For all of the forms of complementary medicine, we need some kind of professional body with clear guidelines, a code of conduct, clear complaints procedures—all of these things we need in place.

  Professor Ernst: We have recently published a little piece of research where we have shown that chiropractors, after having been regulated in the United Kingdom, have totally fallen asleep as to research. That proves the point that I have tried to make previously, that regulation is seen as a substitute for evidence. Once we are regulated, we do not need to show the world any more that what we are doing is any good. That seems to be happening on a major scale and therefore I am happy for regulation as it safeguards consumer issues and so forth but, if it is used as a substitute for efficacy or safety research it worries me.

  Professor Corrigan: Regulation does not mean the treatment is effective. At best, it may protect some patients from being poisoned and it may protect some patients from charlatans. Once you do license them, they are under less obligation then to show that what they do is of any benefit, which is counterproductive.

  Q532  Lord Haskel: Is there any useful guidance for the general public?

  Professor Corrigan: Not that I know of.

  Ms Chatfield: It is not something I have seen, that there is a decreased interest in research. That has not been my observation at all. The decrease in research is due to the drying up of any funding. That is the primary factor that affects the level of research. Certainly within the professions there is still the drive to carry out the kind of research that improves practice. It is not just about proving efficacy but trialling different techniques.

  Q533  Lord Taverne: On the question of guidance, I know that opinion on the panel will be divided but would it not be useful guidance to issue a health warning when so many people do resort to alternative therapies?

  Professor Brostoff: It might be interesting to issue a health warning about going into hospitals these days. If you take malpractice, if you take 10 per cent of hospital admissions being due to drug reactions plus MRSA, plus clostridium dificile, that would be more appropriate at the moment and it is also a much larger problem.

  Professor Ernst: From my perspective, guidance against complementary, alternative therapies is nonsensical. Guidance against unproven or disproven treatments, yes. Many treatments in complementary medicine are unproven or disproven, but not all. Some have very good evidence, not in the area of allergy, I am afraid. In these cases, guidance should favour the usage of these treatments. It is not about a label, complementary versus mainstream; it is about proof of efficacy and safety.

  Q534  Viscount Simon: It seems that allergy sufferers feel as if they are driven to try complementary medicines and therapies because the conventional treatments do not appear to be there. Is this right?

  Professor Ernst: I think all the evidence points to the fact that it is used in addition, as a complement to, rather than because it is not there and therefore we have to use the other type of medicine. The reasons why people seek it out are obviously complex. A level of understanding, empathy and even time which medicine at present does not afford within the NHS is, in my view, a very strong motivator for patients to turn towards complementary practitioners.

  Professor Brostoff: There is a frustration with the availability in the allergy field and the provision in the National Health Service is so limited. My particular interest is food intolerance. If patients do go to conventional allergy clinics, the conventionally trained allergist is often not very interested or involved in food intolerance. For brittle asthma, for example, John Ayres's study in Birmingham was of 60 patients put on an extremely rigid diet. He found that in about a third of the patients their asthma improved very significantly when specific foods were eliminated, and of note these are patients where skin tests and blood tests are negative, so it is a completely different mechanism. I of course would put in a plea for more interest in food intolerance.

  Professor Corrigan: I agree with Professor Ernst. A lot of patients use complementary medicine more as an adjunct to existing therapy than anything else. A lot of it is peer pressure, pressure from the media: I have tried this and it has worked for me for 10 years, these sorts of statements. Interestingly, if you look at studies, whereas many patients use these complementary therapies, a lot of them do not think they are particularly effective. It is almost a thing one does these days, rather like getting a new car. I would also endorse the principle that many patients in this country do not have an allergist to consult and that is a very important factor in people seeking help. One will seek help from anywhere if one is desperate enough. I think we can all understand that sort of sentiment. That has played a role but largely I think it is also peer pressure and modern society that force people to look at these medicines.

  Ms Chatfield: What you call "peer pressure" I would call word of mouth and stories of successful treatment. Certainly that is where most of our patients have come from when we have looked at the motivation for coming. They have heard stories from other people who have been successfully treated. That is why they come. I cannot call that peer pressure. When we are looking at particularly children with allergies, their parents most often bring them because they do not want to use conventional treatment or, if they have used conventional treatment, they are worried about the side effects and the long term usage of that. That is one of the main motivators for parents who bring their children.

  Q535  Viscount Simon: Would I be right in thinking that if more allergy specialists were around the place the demand for alternative medicines might reduce?

  Professor Corrigan: In my view, dramatically, yes.

  Q536  Viscount Simon: Professor Brostoff, is there a role for complementary and alternative medicine in severe brittle asthma?

  Professor Brostoff: What I am interested in, which is food intolerance and aspects of nutrition, I would not call complementary medicine. I would call it mainstream medicine and my brittle asthmatics all go on diets. If I get one in three better, I think that is an enormous yield. Keeping somebody out of hospital six times a year, to me, is not a little matter.

  Q537  Earl of Selborne: There are currently five NHS homeopathic hospitals which offer homeopathic and other complementary treatments such as acupuncture. Should we have more on the National Health Service and should the range of treatments alongside conventional treatments be extended to such therapies as Vega testing and kinesiology on the National Health Service?

  Ms Chatfield: I do not really want to comment on Vega testing and kinesiology. I think that is a separate issue but certainly with homeopathic hospitals we would welcome far more provision of homeopathy on the NHS because at the moment there is very little provision available and it remains the preserve of the people who can afford to pay for it in most instances. We would welcome any opportunity to increase provision.

  Professor Corrigan: I think it is sad that we consider such an option when the conventional and professional allergy services that are available on the NHS currently are so few and so limited. It is possibly a question of priorities, but that should be regarded as a secondary issue. We are all in the business of making people feel better. If people do feel better, even if there is no tangible benefit, one might argue that that might be a suitable alternative to spending more than two minutes with your GP discussing your problems, or even your priest or your mentor. I could not condone expansion of homeopathic hospitals or any other alternative therapy to the detriment of setting up a well accessible, conventional allergy service within the NHS.

  Q538  Lord Broers: I have a simple, technical question about homeopathy and drugs. Is it possible to distinguish between homeopathic drugs after they have been diluted? Is there any means of distinguishing one from the other?

  Ms Chatfield: Only by the label.

  Q539  Lord Taverne: The question was about possibly expanding and financing more hospitals. Do you think, as an alternative to this that, given the shortage of funds in the health service, the present expenditure on these five homeopathic hospitals is justified or can be justified? Ms Chatfield obviously would say it is justified.

  Ms Chatfield: Of course it is justified. I think you will find when you look at the cost effectiveness of homeopathy and what the provision costs, it is a very small proportion of the NHS budget. When you look at putting money into that kind of provision, you will ultimately save money in other areas.

  Professor Ernst: I cannot think of a logical justification for treatments which are disproven or unproven. In as much as these hospitals use proven treatments, they are justified. In as much as they do not, they are not justified.

  Professor Corrigan: I would agree with that and if we are talking about cost effectiveness do not forget that it costs the NHS £100 million a year to treat asthma and allergy, not to mention the socio and economic losses from loss of time at work or school and poor performance in exams. The cost effectiveness of an effective allergy service in this country would be overwhelmingly positive.

  Professor Brostoff: If you take general surgery or most surgical operations, probably 90 per cent have not been put to a true double blind clinical study and we are using empirical methods which sometimes work better than others. If homeopathy is satisfactory to the patient and adds something to their quality of life and keeps them away from the NHS, I would support it fully.

2   In the same paper the authors established that a far higher percentage of homeopathy trials (21 per cent), than conventional drug trials (8 per cent), were of highest quality. This does beg the question as to how we are ever able to trust the conclusions of conventional drug trials. Back

3   It is misleading of Professor Ernst to quote results from systematic reviews of homeopathy as if they are all negative. In actual fact most systematic reviews and meta-analyses are positive, and this includes comprehensive reviews and those focussed on specific conditions including influenza, arthritis and allergic rhinitis. Back

4   Although it is not in the form of randomised trials, surely well-documented use in real life cases over hundreds of years holds some value. Back

previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2007