The NHS in Scotland has scrapped, as a cost cutting measure, the training of junior doctors at Gartnavel, Scotland’s homeopathic hospital; perhaps as a direct result of comments made at the BMA junior doctor conference comparing homeopathy to “witchcraft“.
There is a degree of speculation in the press that this could lead to a reduction of the number of overnight beds available in the hospital (which in 2008 treated 448 in-patients). NHS Greater Glasgow has to save 58.8m (pounds) over the next two years to prevent the budget plunging into the red, and a spokeswoman said the cutbacks were necessary if the board were to meet this target, which has raised hopes/fears that perhaps the homeopathic “hospital” at Gartnavel is itself under threat.
If this were indeed the case, we would do well to hope that the press take a more sensible and less reactionary stance to the closure, and support the role of evidence based practices in healthcare, not the funding of woo. However, some have already come out in favour of the “hospital” remaining open: Robert Brown, Liberal Democrat list MSP for Glasgow, condemned the closure proposal, describing it as:
”perhaps the single most short-sighted financial decision I have seen in a long time”
Dr Reilly, a consultant physician at the homeopathic hospital and honorary lecturer at Glasgow University, said:
”Quite often we are being referred a patient by a GP or specialist who is saying ‘we have tried all we can try’. ‘We are seeing people often that are arriving on six or eight drugs and have been round the houses and have cost the health service a fortune, and what we might do is see the person at intervals and work to bring the condition into order.”
Dr Reilly suggested that the hospital’s holistic approach – addressing the needs of the individual rather than just diagnosing and treating their ailment – reduced burdens on the health service elsewhere. This was a sentiment echoed by Cristal Sumner, chief executive of the Faculty of Homeopathy (which governs training standards in homeopathy for healthcare professionals) who said:
“From our experience, doctors in training learn a great deal about being a good doctor from time spent at any of the homeopathic hospitals across the UK.
“All of the skills above are what I personally would like to see in a doctor when I am ill.”
“It is for most a valued experience because they enhance their consultation skills to enable better diagnosis, learn how to manage chronic health problems in a patient-centred way, and look at a patient as a person rather than as a presenting complaint.
But do these claims hold water? We already know that homeopathy doesn’t work as a system of medicine: it would require the laws of physics, chemistry and everything we know about science-based medicine to be torn up and thrown out the window.
Yet could something about the “holistic” approach to consultations have merit?
There is research into patient centred care that suggests the “holistic” approach of homeopathic consultations could have some merit, despite the fact that homeopathic remedies are nowt but placebos.
In what is often referred to as the “biomedical model”, where the focus is on disease, communication is generally perceived as being physician centered, with early redirection of patients’ concerns, and associated reduced compliance with treatment/prescriptions. This has been linked to negative effects for some physicians as well, increasing malpractice claims and resulting in low professional fufilment.
Patient centeredness is a complex and multi-faceted construct; however it can be thought of as a behaviour that elicits, respects and incorporates patients’ wishes,and is associated with active patient participation (a more egalitarian then paternalistic approach if you like) and improved health outcomes.
The homeopathic consultation is based on “holism” and the “comprehension of the totality of the patient”, and some argue that patient centred care is achieved better through a homeopathic approach. (Hartog, 2009)
However, we come back to the same old argument: is it ethical to provide patients with placebos in the abscence of actual treatment? Is it ethical to spend money on magic water just because patients might feel a little warmer and fuzzier inside? Is there an argument to be made that there is a benefit to junior doctors to learn how the woo-side works?
No, or more technically, we cannot draw any concrete conclusiosn from this line of research. Why?
Well… homeopathic hospitals could be catering to those who are already distrustful of “biomedical” medicine, and thus they interpret the “treatment” as being more effective than it is– which seems likely, given the association with mistrust in mainstream medicine, big pharma conspiracy theories and the support and use of “remedies” that are perceived as “natural”.
Until we can account for any potential effects of these biases, we can’t be sure whether or not the “holistic” consultation in homeopathic practice has some value, or is something that real medicine could benefit from. One thing we can be sure of is that homeopathy has been proved not to work, and if there is any benefit to a holistic approach to consultation, it is something we should introduce to proper real clinical practice as opposed to a justification for the continued existence of homeopathic hospitals funded by the NHS.