and your electron microscope

Category: sCAM

Homeopathic training halted @GARTNAVEL

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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.

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“A reduction of treatment is desirable

Orignallly from the twenty-first floor

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On the 22nd of February this year, the House of Commons Science and Technology committee published “Evidence Check 2: Homeopathy” with its conclusion that the NHS should cease funding homeopathy. It also concluded that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. Furthermore it stated that as they are not medicines, homeopathic products should no longer be licensed by the MHRA.

Those who had been involved in the highly successful 10:23 campaign and the mass homeopathic overdose were understandably pleased – although it remains to be seen what impact the report will actually have. North of the Border Edinburgh and Glasgow Skeptics took part in the mass overdose and were very active in the campaign. However, north of the border, health is a devolved matter and the Sewell Convention states that “Westminster would not normally legislate with regard to devolved matters in Scotland without the consent of the Scottish Parliament”. Thus if Westminster enacts the recommendations of the science and technology committee, Scotland may not be bound to follow.

How much does the Scottish NHS spend on homeopathy?

The NHS in Scotland comprises 14 health boards and we contacted each of them under the Freedom of Information Act to find out how much money they spent on funding homeopathy. The information- 13 provided- is given below (Greater Glasgow and Clyde has a separate section below):

NHS Ayrshire and Arran

NHS Ayrshire And Arran provided the following response:

We are unable to provide this information as it is not centrally recorded. CAM (complementary and alternative medicine) is used in a number of disciplines, however, it is part of the patient’s overall treatment. For example, acupuncture for pain is a recognised treatment in Physiotherapy.  It is the Physiotherapist’s professional opinion as to whether this is part of a full treatment programme. No patients are referred specifically for this treatment.

NHS Borders

NHS Borders has referred patients for CAM outwith Borders or to an independent practitioner for treatments with the following spend per annum:
NHS Borders
Year Spending
03/04 £2,071
04/05 £6,349
05/06 £2,738
06/07 £7,766
07/08 £1,192
08/09 £2,418

NHS Dumfries and Galloway

NHS Dumfries and Galloway spent the following on homeopathy:

NHS Dumfries and Galloway
Year Spending
2005/06 £1770.22
2006/07 £1434.98
2007/08 £1307.26
2008/09 £1551.99
2009/10 (Apr-Nov) £1229.59

NHS Fife

NHS Fife gave the following response:

Routinely, NHS Fife does not refer patients to Complementary and Alternative Medicine and does not provide any clinic within NHS Fife.

Infrequently a patient may have been referred to an external provider but due to the small number of occasions, this information cannot be provided, as it could be patient identifiable.

NHS Forth Valley

NHS Forth Valley does not routinely provide complementary and alternative medicine or fund these treatments.

NHS Grampian

Figures for NHS Grampians’ spend on homeopathy are given below:

NHS Grampian
Year Spending
2004/05 £52,000
2005/06 £48,000
2006/07 £49,000
2007/08 £43,000
2008/09 £41,000

NHS Highland

Figures for NHS Highlands spend on homeopathy and number of patients attending is given below:

NHS Highland
Year Budget Amount Spent Number of Attendances
2004 / 05 26,000 17,808 507
2005 / 06 28,000 15,553 415
2006 / 07 28,800 18,243 422
2007 / 08 29,400 15,633 273
2008 / 09 30,300 13,728 311

NHS Lanarkshire

NHS Lanarkshire provided the following response:

Complementary service set up costs (excluding salaries costs) were initially funded using ward endowment funds / Macmillan cancer support. This included room furnishings, equipment, supplies and training costs. Thereafter, NHSL have supported the ongoing needs of the service. There are two Complementary Therapists employed by NHS Lanarkshire

Individuals are offered 6 sessions thereafter, a further assessment may be carried out and if necessary the treatment period would be extended.

The following therapies are available.

* Aromatherapy
* Aromatherapy Massage
* Indian Head Massage
* Reflexology
* Reiki
* Clinical Hypnosis
* Cranio Sacral Therapy
* Bach Flower Remedies

NHS Lothian

NHS Lothian provided the following information on the cost of homeopathic services:

NHS Lothian cost of homeopathic services
Area 03/04 04/05 05/06 06/07 07/08
Service level agreement with NHS Greater Glasgow 24909 25879 26193 26700 27322
St Johns Service 22390 23262 23544 24000 24560
Dalkeith Clinic inc Leith CTC 57980 53629 43867 61517 48680
Total 102987 92063 78751 112217 84803

The following figures for patients attending homeopathic services were provided:

NHS Lothian homeopathic patients
Year New patients Return Patients Total
2003/04 214 997 1211
2004/05 205 1257 1462
2005/06 295 1457 1752
2006/07 273 1806 2079
2007/08 144 1099 1243
Total 1131 6616 7747

NHS Orkney

NHS Orkney does not provide complementary and alternative medicine care. There are no NHS funded complementary and alternative medicine clinics in Orkney. NHS Orkney does not have a budget for or planned expenditure on homeopathic treatment.

A very small number of Orkney patients (<< 10) have had appointments in Glasgow, at an annual cost of less than £1000.

In 2005 NHS Orkney funded a £30 talk on homeopathy, and spent £449 on an acupuncture course and expenses for members of staff. In 2008 £402 was spent on an acupuncture course and expenses for members of staff.

NHS Shetland

NHS Shetland gave the following information on use of homeopathy:

NHS Shetland
Year Number of Patients Cost
06/07 6 £2,484
07/08 2 £268
08/09 4 £1052
09/10 3 £768 (Figures to date)

Total of 7 individual patients.

These are patients with follow up appointments as we have not referred any new patients since 2008.

NHS Tayside

The use of homeopathic services and their cost in NHS Tayside are as follows:

NHS Tayside Homeopathy Services
Year New Patients Return Patients Clinic Cost Prescribing Cost Total Cost
2004/05 253 1283 Not held Not held Not held
2005/06 214 1292 54,775 700 55,475
2006/07 195 1400 55,100 9,700 64,800
2007/08 203 1379 55,000 14,800 69,800
2008/09 176 1148 58,000 12,800 70,800
2009/10 (interpolated) 58,400 15,700 74,100

NHS Western Isles

NHS Western Isles has not spent anything on providing CAM since 97/98 and does not hold figures electronically for before then.

NHS Greater Glasgow and Clyde and Gartnavel Homeopathic Hospital

Glasgow Homeopathic hospital cost £2,780,189 to build funded by the New Homoeopathic Hospital Endowment Fund. Homoeopathy Endowments can be traced back to a public fund raising effort in the 1930’s to provide a new homoeopathic hospital. The New Homoeopathic Hospital Fund was established in 1974. The New Homoeopathic Hospital as it exists today was built in 1999.  There are 15 staff at the hospital: all, apart from having their basic Medical Degree, have completed post-graduate training in homoeopathy and have attained Membership of the Faculty of Homoeopathy (MFHom).

In 1974, an agreement was reached regarding the homeopathic hospital- the provision was made that the building could only be used for something else (other than homeopathy) if the demand for homoeopathic treatments had diminished to such an extent that the provision of homoeopathic facilities could no longer be justified.

The number of patients treated by the Homeopathic Hospital at Gartnavel is given below:

Number of Patients attending Gartnavel Homeopathic Hospital.
Year Total Inpatients Total Outpatients
2005/2006 476 9788
2006/2007 443 9998
2007/2008 419 8846
2008/2009 448 8629
2009/2010 339 year to date 6272 year to date

In 2004/2005 the inpatient service at the Homeopathic Hospital was reviewed, the conclusion from this review was to continue offering these services and this remains the position today. How much the homeopathic hospital and associated services cost is given below:

NHS Greater Glasgow and Clyde
Year Expenditure
2005/2006 £1.383m
2006/2007 £1.293m
2007/2008 £1.430m
2008/2009 £1.468m
2009/2010 £1.272m as at end Jan’10

…and finally:

NHS Highland also provided me with the following list of what homeopathy referrals should be considered for:

Children With:
Ø      Recurrent infections or ill health
Ø      Skin problems
Ø      Behavioural problems / learning disabilities
Ø      Generally below par in general health

Adults With:
Ø      Asthma
Ø      Headaches and migraines
Ø      Post viral syndrome
Ø      Irritable bowel / abdominal pain
Ø      Allergies
Ø      Pre menstrual / menopausal symptoms
Ø     Post natal depression

In Circumstances Where:
Ø      There is no effective orthodox treatment
Ø      Side effects of current treatment are unacceptable
Ø      A reduction of treatment is desirable

If homeopathic treatment is being provided for all these reasons then I suggest that a reduction of treatment is desirable. A reduction to none, so the people of Scotland can get the safe and evidence based healthcare they deserve.

Stop NHS Scotland funding quackery and Pseudoscience: Join the Facebook group and Sign the petition!

There are no stupid questions…

I recently emailed our MSPs to ask them if they believed homeopathy and compimentary and alternative medicine: I am still waiting for the wheels of government to turn and for many of the relpies to come in.

However in the meantime I did a quick search on theyworkforyou for questions asked about homepathy and the NHS: the following came up and I present to you Holyroods most woefully woeful…

Scottish Parliament written answers — Health: Health (19 Nov 2009) See 1 other result from this answer
Mary Scanlon: To ask the Scottish Executive what action has been taken to support access to alternative therapies such as homeopathy, as promised in the 2007 SNP manifesto.

As promised in the SNP manifesto… Oh dear…

Scottish Parliament written answers — Health: Health (8 May 2008) See 1 other result from this answer
Margaret Curran: To ask the Scottish Executive what action is being taken to improve access to alternative therapies such as homeopathy and facilitate patient choice.

Framing access to treatments that have no scientific evidence to prove trot efficacy as an issue of patient choice is interesting. If a patient believes a trip to disneyworld will treat or cure their ailment/disease/illness or even give them some minor relief from their symptoms should we fund it?

Scottish Parliament written answers — NHS Services: NHS Services (14 Jun 2007)
Mary Scanlon: To ask the Scottish Executive, further to the answer to question S3W-154 by Shona Robison on 6 June 2007, whether patients can access free treatment, paid for by the NHS and provided by an independent homeopathy practitioner, where patients and their clinicians consider that homeopathy is an appropriate form of treatment but is not provided as an NHS service.

This question strikes me as nothing more then proposing a license for snakeoil salesfolk to get their mitts on NHS funding. As is the following:

Scottish Parliament written answers — NHS Services: NHS Services (6 Jun 2007)
Mary Scanlon: To ask the Scottish Executive whether all patients receiving homeopathy treatment will have their treatment fully funded by the NHS.

Scottish Parliament written answers — Mental Health: Mental Health (18 Aug 2004)
Mary Scanlon: To ask the Scottish Executive what action is being taken to give patients with mental health problems access to homeopathy treatments.

It doesn’t work! Should they be given access to any old treatment? An odd position for a Tory to take given they are big on efficiency savings and cutting public sector waste.

I find it particularly worrying that people are pushing for mental health treatment to be magic water… Using is should more correctly be a symptom of mental health problems than considered a treatment!

Scottish Parliament written answers — Health: Health (7 Feb 2003) See 1 other result from this answer
Mary Scanlon: To ask the Scottish Executive, further to the answer to question S1W-32836 by Malcolm Chisholm on 13 January 2003, whether practitioners will be encouraged to prescribe homeopathic medicines, given the cost of branded prescriptions, and what action is being taken to measure clinical effectiveness of homeopathy practice and medicine.

Practitoners should be “encouraged” not to treat their patients! The mind truly does boggle! Are not enough of those nasty Doctors prescribing magic water?

Scottish Parliament written answers — Health: Health (16 Jan 2003)
Mary Scanlon: To ask the Scottish Executive how many statutory registered health professionals currently practice homeopathy.

Actually that’s a question I’d like an answer to – i’d also like to know who so I can avoid being treated by the wooful!

Scottish Parliament written answers — Health: Health (16 Jan 2003)
Mary Scanlon: To ask the Scottish Executive how many health professionals have received training in homeopathy as part of continuous professional development programmes in each of the last five years.

I’d also like to know this as well – particularly if this course is NHS funded…

Scottish Parliament written answers — Health: Health (10 Dec 2002)
Mary Scanlon: To ask the Scottish Executive what consideration it is giving to reviewing the report Complementary Medicine and the National Health Service – An Examination of Acupuncture, Homeopathy, Chiropractic and Osteopathy of November 1996 and recommending the integration of complementary medicine in the NHS.

I’m hoping the answer was “none”…

Scottish Parliament written answers — NHS Waiting Times: NHS Waiting Times (9 Jul 2002)
Mary Scanlon: To ask the Scottish Executive what the current average waiting times are for homeopathy treatment in each NHS board area.

Well I don’t know about the waiting time for homeopathy is but the waiting time for treatment is infinite!

But you know what they say about stupid questions…

There are no stupid questions only stupid people.

McCarthy Madness

Jenny McCarthy is one of the leading lights of Americas anti-vaccination movement (vocal to the extent that some sceptical wag has created this  and her most recent pronouncement relates to the discrediting of the paper that many blame for launching the MMR “controversy” (Or more accurately the Medias MMR hoax). Read the rest of this entry »

Homeopathy: the air guitar of medicine

Homeopathy: the air guitar of medicine. (As christened by Peter Harrison)

Homeopaths are notoriously wedded to the idea that giving people water with nothing in it is better than giving them medicine.

Which just goes to show… You can lead a homeopath to science but you can’t make them think.

conversely you can take a scientist to homeopathy but you can’t make them swallow it. (As Andy Lewis of quackometer kindly pointed out although the events of 1023 might make some question that point!) Mainly because scientists require evidence and the like to accept the healing properties of the magic water…

One of the arguments homeopaths like to put forward is that big pharma is a evil and this somehow means homeopathy works…

Well ok there are issues with big pharma but take Nestle for instance. The babymilk debacle didn’t somehow make thin air chocolate does it?

If it did though it could explain the obesity epidemic.

Read the rest of this entry »

Flowchart Friday!

Here’s to having insomnia ridden beer addled ideas!

In part inspired by the “debate” on the #ten23 hashtag on twitter and the moronic mewing sprouting up on online articles up and down the land here are a couple of flowcharts. Read the rest of this entry »

Fun for skeptics and believers alike!

There has been some hoohaw over on natural news courtesy of everyone’s favourite healthranger (note that r is but a short keypress away from d…)  Mike Adams (who I have blogged about before here). It seems the twitter based shorty awards disqualification (more here and here and here) and the 1023 campaign may have broken his fragile little naturopath mind.  His ranting here is impressive – it’s scary though to see how quickly not getting ones own way translates into vast and mysterious conspiracies though… How do these peoples minds work? I don’t mean in a general why do they think what they think but literally how does one persons brain cope with so much nonsense and cognitive dissonance?

My mind boggles just trying to conceive it!

Read the rest of this entry »