David Tredinnick is conservative MP for Bosworth (he was suspended without pay during the cash for questions scandal) and very keen on alternative therapies. Here is a fabulous speech from him in parliament yesterday. As you can see, he talks up the use of homeopathy as a treatment for HIV, malaria, and a whole host of other problems, including TB, urinary infections, diarrhoea, skin eruptions, diabetes, epilepsy, eye infections, intestinal parasites, cancer, and gangrene. He also talks about ill-informed media coverage and a dirty tricks campaign.
I’ve written him a quick email, which I’ve pasted below.
David Tredinnick (Bosworth, Conservative)
It is unusual to start a debate at quarter to two in the morning these days, although a few years ago we were regularly here a lot later. I am pleased to have the opportunity to introduce this important debate about the threat to the homeopathic hospitals. Their very survival may be at stake and I look forward to hearing from the Minister.
This debate comes at a time when support for homeopathy is at an all-time high, including in the House, with one third of Members signing early-day motion 1240 in the last Session, in support of homeopathy. The Government claim to support choice in health care, but as far as homeopathy is concerned, they are reducing choice. It is not commonly known, but homeopathy has always been available on the health service because its founder, Nye Bevan, had a homeopathic doctor and insisted that that was the case.
In the UK we have four homeopathic hospitals, one in Scotland and three in England. I attended the opening of the beautiful new Glasgow homeopathic hospital before devolution, and it now of course comes under the purview of the Scottish Parliament. I understand that that hospital is protected since a successful campaign in 2004, but that is not the case for the three English hospitals—the Royal London, Bristol and Tunbridge Wells homeopathic hospitals.
The three hospitals are fully integrated into the NHS. They all form part of their local NHS trusts and are staffed by statutorily regulated health professionals with additional training in complementary medicine. All receive patient referrals through normal NHS routes. They have some of the highest patient satisfaction ratings in the NHS and the majority of patients report improvements to their lives across a range of chronic conditions. The treatments employed are clinically safe and cost-effective. They often avert multiple referrals and treatments that many patients find ineffective and the cause of side effects. In addition to homeopathy, the hospitals now offer a full range of complementary therapies.
The flagship hospital is the world-renowned Royal London Homeopathic hospital. I have been the chair of the parliamentary integrated health care group and I used to be the treasurer of the all-party parliamentary group for alternative and complementary medicine. For almost all of my 20 years in this place, I have been an officer of one or other group, so I have had a long association with the Royal London and I believe it to be a very valuable asset. It is the largest and best integrated public sector provider of complementary medicine in Europe. It is also part of the University College London Hospitals NHS foundation trust.
The Royal London provides some 25,000 new and follow-up out-patient appointments a year. Until recently, the number of referrals had been steadily increasing. What has gone wrong? Well, eight primary care trusts have withdrawn their contracts from the Royal London in the last 18 months and patient referrals are down by 20 per cent. on the same period last year. There is great uncertainty about the intentions of the host PCT Camden and its neighbour Islington. If they were to withdraw their support or substantially reduce it, the consequences for the hospital would be very serious. The reduction in referrals has meant that parts of the newly developed building—I attended its opening—are now being used for other services. Despite those problems, the hospital is in discussion with the trust about the proposed polyclinic; it is developing integrated care pathways, integrating complementary and conventional approaches; and, as always, it is pioneering this field of health care.
As for the other two hospitals, West Kent PCT is responsible for the Tunbridge Wells hospital and, sadly, it will withdraw its support from April 2008. That decision has been temporarily rescinded pending a legal challenge by patients. I urge the Minister to look closely at what happened at Tunbridge Wells, where the decision was very unwelcome. Bristol homeopathic hospital has also suffered considerable cuts.
So, why is there a problem? The Government claim that they are increasing choice, but the impact from the perspective of a homeopathic hospital is quite different. If the Minister reflects on the White Papers that have been published in recent years, he will see that they all suggest that choice will increase. “The NHS Improvement Plan”, published in 2004, states:
“By 2008, patients referred by their GP will be able to choose any provider able to meet NHS standards and to deliver care at tariff.”
That appears to guarantee the right to choose treatment at the homeopathic hospitals. The December 2003 document, “Building on the Best: Choice, Responsiveness and Equity in the NHS” stated that NHS services should be “more responsive” to patients. The January 2006 document, “Our health, our care, our say” states:
“We will give people a stronger voice”—
so that they can see a service improvement. The 2004 White Paper stated the intention to give the public more informed choices as regards their health. The Government are certainly failing to do that as far as the homeopathic hospitals are concerned.
Another issue is the introduction of evidence-based practice, which tries to specify the way in which professionals or other decision makers should make decisions. Naturally, as its name suggests, it places a greater emphasis on evidence. The practice guide, however, asks for evidence-based design and development decisions to be made after reviewing information from repeated, rigorous data-gathering. That militates against complementary and alternative medicine, where there may not be a huge number of rigorous or repeated databases to work from. There is not a vast quantity of studies and that has been used against complementary medicine as an excuse. The methodology of assessing CAM might also be unfamiliar to primary care trusts. It might also be difficult to record accurately exactly how homeopathy, for example, treats. It is always different for individual patients, and that can be difficult to record. Sometimes, the treatments require a combination of remedies.
My next point is that homeopathy does not fit normal—that is, orthodox—methods of assessment. For example, the scale of prescribing is in reverse so that the weaker the dose, the more powerful or effective it is. That subject has always been hotly disputed by many doctors, but homeopathic treatments have been operating on the reverse scale of prescribing for 200 years. Some of the most powerful—the constitutional remedies—are so diluted that they can hardly be detected. There are similar problems with acupuncture and its acceptance, as some doctors and commissioners do not necessarily believe in meridians. The same issue occurs with herbs that are unknown in this country.
Another simpler explanation of why complementary services, and the homeopathic commission in particular, have been cut recently is that they are the easiest therapy to cut. Just as advertising gets cut when times get hard in business, when the primary care trusts try to balance their budgets under the new devolved arrangements they often go for homeopathy and other complementary therapies as the soft target.
The most important point that I want to make to the Minister is that I believe that we need proper guidelines on commissioning for primary care trusts. I have said as much several times at Health questions. At present there are no proper guidelines, with the result that PCTs have little direction at a time when many are under financial pressure. Indeed, they often cite that financial pressure as one of the main reasons for not commissioning homeopathy.
Also, PCTs claim that there is not enough evidence to support the use of homeopathy. However, the Royal London Homeopathic hospital has conducted more than 130 randomised and controlled trials of homeopathic treatments that show very effective results, so surely it is in the Department’s interests to make sure that those results are publicised to PCTs.
The Smallwood report took a look at the cost-effectiveness of complementary medicine. Smallwood argued strongly that some complementary therapies were more effective and cost-effective than traditional treatments. He also wanted the National Institute for Health and Clinical Excellence to assess their cost-effectiveness, but that has never been done. I hope that the Minister will be able to help with that. I intend to write to the Public Accounts Committee to see whether it will undertake an assessment, and I have had discussions to that effect with
my hon. Friend the Member for Gainsborough (Mr. Leigh), who is that Committee’s Chairman.
Another problem that homeopathic hospitals have had to face is ill informed and hostile media coverage, as well as a dirty tricks campaign. The Minister may recall that in May 2007 some doctors issued a spurious document—printed on official paper, with the NHS logo—claiming that homeopathic services should be decommissioned. The Government have never written to PCTs to refute that document.
I want to allow the Minister time to reply, because the fate of the Royal London Homeopathic hospital is of great concern internationally. I shall illustrate that, and the importance of the treatment, by looking at the results that have been achieved in Africa by homeopaths who have been trained at the hospitals that I have mentioned. Those results are especially instructive, as the homeopaths involved are treating patients with AIDS, HIV or other serious diseases such as malaria, in countries where the problems are very great.
For example, at Kendu bay in Kenya’s Nyanza province, the Abha Light foundation is an organisation that partners mothers and orphans in the rural community who are suffering from AIDS, and it has had great success in returning those people to an active life. There has also been considerable success in the use of the local herb product called neem as a homeopathic medicine. It has produced what has been described as
“a convincing reduction in malaria attacks”
in a highly endemic area.
I shall close with a note about what is happening in Swaziland in southern Africa. I know a homeopath who has worked there well, and I asked her for a description of what was happening in the clinics there. Her letter to me states:
“Seven years ago I introduced Homeopathy to Swaziland, providing a community of 10,000 people with the only health care available to them. In addition I travelled around with a mobile clinic reaching other very remote areas. On an average day I could see up to 50 patients…Five years ago I built a homeopathic clinic…it was so successful that the people wanted to ensure my tenure which ensured their continued treatment on a daily basis.”
The letter goes on to say that other homeopaths were brought in to help, and that the clinic treated patients who came from as much as 300 miles away.
“Aside from the predominant treatment for HIV, TB and malaria, treatment is being given for many other common ailments such as urinary infections, diarrhoea, skin eruptions, diabetes, epilepsy, eye infections, intestinal parasites, treatment from pregnancy to childbirth, to more serious but locally common ailments like cancer, gangrene, toxaemia…and general injuries…In other words the list is endless.”
The letter states that the homeopathic treatments have achieved success rates of close to 100 per cent.
“As a result many lives have been saved, and pain and misery alleviated, in a community which can simply not afford orthodox treatment even if it were available.”
That is a very important issue for developing countries. Homeopathy is so inexpensive that it is available to everyone. When homeopathic services are introduced, they tend to increase in size very quickly. My acquaintance’s letter goes on to say:
“The low cost of the remedies and the relatively short dosage period, together with the positive results of the treatment are responsible for the expansion and ever increasing demand in a Country that is unable to give the majority of the population even the most basic of health care. Therefore, Homeopathy is excellent value and has saved countless lives as well as alleviating the suffering of the countless unemployed, elderly and orphaned in Swaziland.
We will of course continue with our work. At the end of a day, when we simply cannot see any more patients, the remaining untreated patients usually start fighting among each other as to who will be the last to be seen. A true vote of confidence!”
I hope that the Minister can reassure me on guidelines for primary care trusts so that we have more effective commissioning. I hope that he will refute those statements made in the name of his Department and that he will commission NICE to look at the cost-effectiveness of homeopathy in line with the request of the Smallwood report. I look forward to the Minister’s reply.
More worrying than the claims about homeopathy being brilliant for every illness known to mankind is the warm response this speech received from the Labour health person, you can read the rest here.
I should say that I am completely agnostic on the question on homeopathy on the NHS, and I think my position on the merits of placeboes is well known. However what does worry me is misinformation, and the wider issues of what homeopaths themselves do: undermine vaccination campaigns, give foolish advice on serious illnesses, attack medicine, attack individual people, undermine the public’s understanding of evidence, and so on.
I’ve just pinged David a quick email, hopefully I’ll hear back from him.
I was very interested to read your speech on homeopathy in parliament yesterday. I write the science column in the Guardian, if you had any examples of ill informed media coverage on homeopathy, where people get things wrong, I’d be very pleased to write about it, do please send me links or dates I can pull out of the archives?
Also, if there are homeopaths who are unfamiliar with research methodologies but who would like to do some research on their work, and who want to make sure that the research they are doing is a “fair test” – the most important question in any research – then I’d be very happy to help out, and would be very happy to discuss this further. There really is no reason not to do proper research on alt med, and of course there might well be something in some of it.
Sadly, from the complaints of homeopaths about funding, it seems that homeopathy pill companies such as Boiron (£500 million) are not forthcoming with funds.