Society of Homeopaths make themselves look silly

When they are not silencing criticism through cowardly legal means, the Society of Homeopaths (SoH) put out the occasional press release extolling the virtues of homeopathy. Last month they issued this press release citing a House of Lords report in justification of patients turning to homeopathy as a treatment for various allergic conditions.

A House of Lords report published today (wed 26 sept) recommends the Government takes urgent action to address the “epidemic” of allergies in the UK, and acknowledges that many patients are turning to complementary medicine for help.

The report of the science and technology committee, urges ministers to take concrete steps to tackle the lack of specialist clinics, and inadequate allergy training for doctors within the NHS, which it says is leading to a poor service for patients.

As well as a plan of action to tackle the problem within the NHS, the report recommended that “robust research into the use of complementary diagnostic tests and treatments for allergy should examine the holistic needs of the patient, assessing not only the clinical improvement of allergy symptoms, but also analysing the impact of these methods”.

Kate Chatfield, representative of the organisation’s research ethics committee, gave evidence to the science and technology committee earlier this year. She told them: “With the kind of holistic treatment that we are measuring in homeopathy, we still do not have an outcome measure that successfully can measure the effect on every level. By their very nature, randomised control trials are trying to measure very specifically. Homeopathy is going to affect the whole person. It is very difficult to measure an outcome for a whole person.”

The Society believes that homeopathy should form part of an integrated approach to treatment. Kate explained: “For an increasing number of people homeopathy is becoming the treatment of choice for allergies as it offers a more gentle alternative to conventional approaches, such as antihistimines and steroid-based skin preparations. Homeopathy is a holistic approach and treats each person as an individual. Allergies happen when the immune system over-reacts to substances which should not cause a problem, and with carefully selected remedies a homeopath will aim to strengthen the immune system.

She explained that results from several recent observational studies indicated that homeopathy appeared to have high levels of clinical effectiveness in the treatment of people with allergy related problems such as eczema and asthma2.

It is the experience of members of the Society that patients in the vast majority of cases seek homeopathic treatment when they have exhausted the conventional route, which has good results in palliating the symptoms but does not treat the underlying cause. Remedies can be used alongside conventional medication where needed.

Where to begin? Point out that they admit they can’t prove homeopathy’s effects to a credible standard? The strange insistence that they can’t measure treatment outcomes as homeopathy is holistic, so presumably someone’s allergy clearing up is lost in the general holisticness? Criticise the fallacious argument that people are choosing it, therefore it must be of benefit? The inelegant simplification of immunology? The appeal to ‘observational studies’, perhaps better known as anecdotes? Or their positioning of homeopathy as the cure to try when all else has failed?

Perhaps it would be best to examine the House of Lords report that they are so keen to draw attention too, in particular the section on complementary medicine. Rather than paying compliments to complementary treatments the report is scathing in its analysis.

On the subject of evidence……….

8.23.The ways in which complementary therapists diagnose allergic conditions are considerably different from those used by conventional practitioners. We were therefore disappointed at the lack of response from complementary practitioners to our Call for Evidence. Ms Chatfield explained that “in homeopathy we have a very different definition of diagnosis. It is not diagnosing a specific allergy according to a specific allergen. A homeopathic diagnosis for us literally means finding the right remedy for the person, so it is not a conventional diagnosis in that sense”

When questioned on the evidence from clinical trials in support of complementary treatments, including homeopathy, Professor Ernst stated:

8.28…………..”there are virtually dozens of complementary therapies that have been submitted to clinical trials … for no treatment modality is there good evidence that it is clinically effective in asthma, atopic eczema or hayfever”

On the subject of the consequences of ignoring conventional in favour of complementary therapies…..

8.30.There were concerns expressed to us about the indirect consequences from complementary practices used in isolation from more conventional medicine. Professor Corrigan was worried that, in his view, homeopathic consultations may be dangerous because “they may delay accurate, valid and pressing diagnosis” (Q 523) and the National Allergy Strategy Group forcefully made the point that “many patients get the wrong diagnosis. This sometimes leads to medical harm; or financial problems for the patient”

Ms Chatfield’s claim about treatment outcomes was contradicted by Professor Ernst……

8.32.It was also felt that research studies might ask the wrong questions when analysing complementary therapies. Professor Ernst noted that “we have, if anything, too many quality of life measurements rather than too few these days … in complementary medicine, it has largely been adopted so I do not know of any reasonably good trial that totally neglects the patient’s view in that sense.” But this was countered by Ms Chatfield who commented that although quality of life assessments had improved over the last few years, “with the kind of holistic treatment that we are measuring in homeopathy, we still do not have an outcome measure that successfully can measure the effect on every level. By their very nature, randomised control trials are trying to measure very specifically. Homeopathy is going to affect the whole person. It is very difficult to measure an outcome for a whole person”.

The SoH also missed out the important qualifier to the committees recommendation that “robust research into the use of complementary diagnostic tests and treatments for allergy should examine the holistic needs of the patient, assessing not only the clinical improvement of allergy symptoms, but also analysing the impact of these methods”. The full text reads (my emphasis)

10.36.We recommend that robust research into the use of complementary diagnostic tests and treatments for allergy should examine the holistic needs of the patient, assessing not only the clinical improvement of allergy symptoms, but also analysing the impact of these methods upon patient wellbeing. Such trials should have clear hypotheses, validated outcome measures, risk-benefit and cost-effectiveness comparisons made with conventional treatments. Allergy centres will allow the collection of information about any indirect consequences of misdiagnoses or delayed treatment.

On the subject of regulation the report states that……………

8.41.Many witnesses were outraged at the lack of regulation for some complementary practitioners and allergy diagnostic self-testing services. According to Allergy UK, “currently there is nothing to guide the consumer on whether the test, clinic or service has been clinically proven in any way” (p 293). The Royal College of Pathologists emphasised that “regulation of non-NHS clinics and over-the-counter treatments for allergy is not adequate—extensive evidence that it leads to direct harm to individuals is lacking, but there is clearly a legitimate concern that ineffective or misleading advice may be harmful, costly and may divert patients from effective evidence-based interventions” (p 126).

In their defence the SoH claimed that……..

8.43…..The Society of Homeopaths noted that its members were “subject to a rigorous Code of Ethics” and that it was also “a key player in the Council of Organisations Registering Homeopaths … working to establish a single register for the profession” which would allow patients and healthcare workers “to be sure of the professional standards, competency and accountability of the homeopaths they employ”

Of course this is a highly contentious statement given the SoH’s recent way of dealing with complaints that some of its members do not adhere to its Code of Ethics.

As always Professor Ernst has some wise words on the subject……….

8.44.However, Professor Ernst was concerned that regulation was “seen as a substitute for evidence,” and that regulation of complementary therapies would cause further research into their efficacy to cease. This was agreed with by Professor Corrigan, who added that “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”

In summary:

It is egregious and misleading for the SoH to use this report to justify the use of homeopathy as a treatment for allergies. It is wrong to highlight the reports criticisms of the lack of allergy training in NHS staff and ignore the strongly critical comments on homeopathy. The Society of Homeopaths represent a profession which purports to treat patients with no evidence base and little if any regulation. The final judgement on homeopathy comes from the words of Ms Chatfield herself. Despite her claim that “A homeopathic diagnosis for us literally means finding the right remedy for the person”, she has this to say on the difference between various homeopathic remedies when questioned by Lord Broers:

Q538 Lord Broers:……… 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.

Thanks to J, FlammableFlower, Dr* T, Nekomatic, wewillfixit, MJ Simpson, Mojo, et al.,