The House of Commons Science and Technology Committee has just reported back after its Evidence Check on Homeopathy and the results are well worth reading. It is expected and accepted that the UK government should base its decisions and policy on evidence and similarly manage government expenditure on the same basis.
The committee consisted of liberal democrat MP Phil Willis, and thirteen other MPs drawn from across the political spectrum and its remit is to examine the expenditure, administration and policy of the Government Office for Science.
The purpose of the Evidence Check is to look at government policy and examine on what evidence it is based. The first Evidence Check was carried out on Early Literacy Interventions, and this, the second looked at homeopathy. In particular it looked at the provision of homeopathy through the National Health Service, and also at the licensing of homeopathic products through the Medicines and Healthcare products Regulatory Agency (MHRA).
Homeopathic treatments in the UK were available before there was any mechanism for the control and regulation of prescription medicines, and since 1948, there have been some homeopathic hospitals funded by the NHS. So the committee examined the evidence used to support the continuing policy of providing homeopathic remedies on the NHS. In particular, in cash-strapped times, they questioned whether it can be justified to put state funding into these therapies.
To examine the evidence base, they invited written and oral submissions from the homeopathic industry, the National Health Service, government advisers and a range of experts both supportive and critical of homeopathy. They outlined in the report what sorts of evidence can be accepted as proof of efficacy, and also of effectiveness. The distinction is important, especially to supporters of homeopathy.
Efficacy tests whether treatment works under ideal conditions, whereas effectiveness looks at whether it will work in real-world circumstances. For example, efficacy may be proved in a clinical trial, but the side effects may make it unacceptable in the real world. It would thus be efficacious but not effective. Supporters of homeopathy have argued that although efficacy cannot be shown, effectiveness can.
The report examined this position in detail and presented an analysis of how a treatment can appear to be effective without being efficacious. It is called the placebo effect. Clearly, if the evidence on homeopathy showed it to be the placebo effect, then government spending on prescribing placebos would raise ethical issues. And if the evidence which has been used to guide government policy was based on anecdotal reports from people who feel better without evidence of being better, then this undermines the evidentiary basis of health decisions.
The report looked in detail at the evidence for efficacy provided by the British Homeopathic Association. The BHA claimed: "Four out of five comprehensive reviews of systematic RCTs (randomised controlled trials) in homeopathy reached the qualified conclusion that homeopathy differs from placebo." Unfortunately, that was blatantly untrue. Professor Edzard Ernst pointed out that the reviews did not reach the conclusions claimed by the BHA. In fact, quite the reverse. And in selecting their evidence, the BHA had ignored the systematic reviews and meta-analyses which arrived at negative conclusions.
After evaluating the evidence presented, the committee reached the conclusion that "the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos." And the UK government shares that view. Despite the opportunity, the BHA could not find any evidence for the efficacy of homeopathy. In addition, it could provide no credible explanation for why it might ever work.
So the UK is funding hospitals based on a form of treatment which is demonstrated to be no better than a placebo. That means the practitioners are regularly deceiving patients about the treatment they are receiving and doing so with state funding. Clearly this is an embarrassing position for the government to be in.
Part of the justification for this state of affairs lies in the fact that homeopathic remedies have eluded regulation and control. Back in 1968, the Medicines Act required medicines to have a Product Licence of Rights (PLR) before they could be sold on the UK market. Unfortunately, anything already there got an automatic PLR and that included almost all the homeopathic remedies.
When in 1992, the European directive introduced a "simplified scheme" for homeopathic remedies, there was no requirement for any demonstration of efficacy so once again they slipped through the regulation process. Then in 2006, the MHRA tried to combine the regulations into a National Rules Scheme which meant that the products had to be registered. The application was supposed to be "supported by a dossier on quality, safety, and efficacy".
Once again though, homeopathic remedies were made exempt so they never were required to have evidence of efficacy, despite the MHRA's own rules demanding it. Whereas other health preparations have to abide by rules about labelling and patient information, homeopathic remedies do not. In the UK, they can continue to claim that they treat various conditions despite there being no active ingredient. It remains legal to misinform patients with spurious claims of efficacy because the MHRA has granted licences to these products.
This report's damning conclusions should make the UK government sit up and take notice. Already one health care trust has closed its homeopathic hospital and others are set to do the same. Universities have, with a certain amount of embarrassment, closed down their degree courses in homeopathy and there are questions being asked about vocational courses and their evidentiary basis.
Homeopathy is a very successful marketing of the placebo effect, providing sugar pills with no active ingredient. It is based on lying to patients and is therefore unethical. It is to be welcomed that the UK government has produced this report but there remains the rather shadowy influence of bodies such as the Prince's Foundation for Integrated Health which promotes Woo practices under the guise of patient choice and integration. But integrating the placebo effect as a main form of treatment is both unethical and pointless.
The quacklash is getting under way.