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Homeopathy and the NHS: doing no harm?

Steve Ainsworth
Medical Journalist

The Royal London Homoeopathic Hospital is the leading centre for complementary medicine in the NHS. It joined University College London Hospitals in April 2002, the merger coinciding with the government's commitment to integrate complementary and conventional care within the NHS.

There are other NHS homeopathic hospitals; Bristol and Glasgow each boast such establishments. Less well-known was the homeopathic hospital at Tunbridge Wells, which the local primary care trust (PCT) closed two years ago, despite a judicial review sought by angry patients. Recently, however, all NHS homeopathic services have been placed under threat by a committee of MPs.
 
What exactly is homeopathy?
Way back in 1796, a German doctor named Samuel Hahnemann began promoting a theory he called the “law of similars”. Quinine, widely used to treat malaria, also produced side-effects similar to the symptoms of malaria itself. On the strength of that observation, Hahnemann hypothesised that diseases are best treated by prescribing substances that, in healthy people, produce symptoms identical to the disease.

Local clinicians thought he was a charlatan and took legal action to prevent him from practising. Undeterred, Hahnemann published his ideas in a book, Organon der rationellen Heilkunde (Organon of Rational Medicine). The book, containing a complete exposition of Hahnemann theory, by now named Homöopathie, became a bestseller.

Hahnemann's theory of “homöopathie” was not just confined to his “law of similars”. He also believed that large doses of drugs made patients worse. Turning common clinical practice on its head, Hahnemann proclaimed that medicines became more effective by being diluted.

Given the state of medicine in the 18th century this part of Hahnemann's theory was undoubtedly true. Giving patients less, rather than more of the mercury, arsenic, opium and other toxic substances frequently prescribed would certainly have been beneficial.

According to Hippocrates the most important rule of medicine is “first do no harm”. And Hahnemann certainly followed that principle. However, whether homeopathic remedies really did any good, as opposed to simply not causing any harm, remained an open question.

Two centuries later, medical science has moved on. Homeopathy has been criticised for being impossible to explain chemically. Homeopathic medicines require their “active” ingredients to be diluted to such a degree that they may contain little more than a molecule or two of the original substance - perhaps even none at all. Can such a tiny quantity have any pharmacological effect?

Supporters of homeopathy theorise that the water molecules can somehow “remember” what was previously diluted in them. So far no repeatable scientific experiments have shown this to be true. Factually, however, many of those who take homeopathic remedies for their illnesses do get better. Yet, as critics point out, so do many ill people who take no medicines at all. Chance and the placebo effect may well account for any apparent effectiveness of homeopathy.

To gain scientific acceptance, homeopathy must demonstrate that its remedies are superior to no treatment at all. Such conclusive evidence has never been forthcoming.

Occasional studies do suggest that homeopathic remedies might have some effect - others, such as one which appeared in the Lancet in 2005, insist that results were no better than placebos. The National Institute for Health and Clinical Excellence (NICE) has been asked to take a look at the subject but has so far failed to deliver its opinion.

Meanwhile, not everyone working in the NHS is happy that it provides homeopathy services. Michael Baum, Professor Emeritus of Surgery at University College London, says, “Homeopathy is to medicine what astrology is to astronomy: it's witchcraft - totally barmy, totally refuted”.

Millions of patients, not least her Majesty the Queen, who reportedly never travels without a supply of homeopathic remedies to hand, remain convinced that homeopathy works. Real evidence, however, remains tantalisingly absent.

Yet, if anyone could prove homeopathy is effective there's a lot of money to be made. In the USA, the James Randi Educational Foundation has an open offer of a million-dollar prize to anyone who can produce scientific evidence that homeopathy actually works. The challenge began life in 1964, when the America illusionist and arch-sceptic, James Randi, put up $1,000 of his own money as a prize for the first person who could provide objective proof of anything paranormal (clairvoyance, graphology, astrology, phrenology, faith healing, psychic surgery - and homeopathy) under laboratory conditions. Despite a thousand attempts to claim the prize there have been no successes to date.

Back in Britain, three years ago, dozens of MPs signed an Early Day Motion that, “This House welcomes the positive contribution made to the health of the nation by the NHS homeopathic hospitals; notes that some six million people use complementary treatments each year; and believes that complementary medicine has the potential to offer clinically-effective and cost-effective solutions to common health problems faced by NHS patients”.

Sadly for those enthusiasts, a report published on 22 February 2010 by the House of Commons Science and Technology Committee came to very different conclusions. The Chairman of the Committee, Phil Willis MP, said, “We were seeking to determine whether the government's policies on homeopathy are evidence-based on current evidence. They are not”.

The Committee's report was unequivocal: “The government's position on homeopathy is confused. On the one hand, it accepts that homeopathy is a placebo treatment ... We conclude that placebos should not be routinely prescribed on the NHS. The funding of homeopathic hospitals - hospitals that specialise in the administration of placebos - should not continue”.

It seems likely that this Parliamentary report will bring to an end the long association of the NHS with homeopathy; but with millions of supporters, MPs may not succeed in consigning homeopathy to the history books just yet.

Reference
1. House of Commons Science and Technology Committee. Fourth Report. Evidence Check 2: Homeopathy. Available from: www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4502.htm