‘But I agree we live in times where everyone thinks they are entitled to something for nothing. they want free healthcare, free education, free social care, free roads, etc. but at the same time they want to have sufficient disposable cash (i.e. low taxes) for the faster car, the bigger house, the nicer holiday, etc. and that for me is the situation which is not sustainable’.

Steve, I have followed some of the debate and tend to agree with most of your conclusions especially the above!
However, I tend to think that the waters are much muddier than many here seem to suggest (in terms of practically dealing with pain and suffering in the clinic). I work as a NHS Physiotherapist primarily in GP clinics , formerly in teaching hospitals with specialist consultants in both orthopaedics and pain management.
Many people like to think that things are scientifically rational and that care is optimised to treat ‘rational people’ with ‘rational’diseases’…..After nearly twenty years dealing with medically unexplained pain syndromes, chronic pain and the ‘no mans land’ between orthopaedics and psychology I can assure most people that a lot of people out there remain a mystery. Sometimes this is due to fragmentation of care , often it is due to a dualistic philosophy perpetuated by outmoded thinking and failure to think of the person in a holistic context.
There does seem to be a lot of Homeopathic bashing and it is an easy target.
Personally, Homeopathy does not interest me that much neither do most ‘modalities’ that get discussed (acupuncture,manipulation etc etc). What I do believe is that there is nothing mere about the placebo or nocebo phenmenon (which clinics are often very good at inducing. For example a lady with a lifelong hx of trauma,’ptsd’ anxiety etc was sent for ‘breathing exercises’ ….the clinic had told her she may need a lung transplant ….this leads to further catastrophisation .
Many people I see are informed that there discs/hips etc ‘are out’ , that they have spines of an old person etc –iatrogenic disability in our inactive society often caused by misinformation is a big part of my caseload. This nocebo situation needs to be understood by many in the medical profession and Benedetti has done some interesting Fmri studies in this area see’When words are painful: Unraveling the mechanisms of the nocebo effect’….Many people seem to need or have been conditioned into expecting help for self limiting problems or problems of living. There is abundant scientific evidence that many common problems can be assisted through ‘self help’ i.e movement restoration , ‘meditation’ or low cost stress reduction techniques. Indeed, I have tried to set these up myself at no cost to patients or the doctors locally…..These measure have not been acceptable and none of the doctors have expressed any interest in coming along or referring patients…..Self management is not a popular option especially if it is ‘free’ —–placebos work much better if you pay for them and they are delivered by a credible hierarchy figure (perhaps I have to wear the bow tie and inject saline for best effects?
I too think that the NHS is the best way to deliver care and also agree that in Scotland (particularly away from the central belt) that the service is largely excellent. However, I sense on a Monday morning now matter how much money you throw at it or doctors that you employ many people will continue to moan or demand more……
I enjoyed Nic Humphrey’s take on understanding the placebo response here (talking with Richard Dawkins).The debate is interesting re self – cure.
www.youtube.com/watch?v=e1AQPue7FEM

‘But I agree we live in times where everyone thinks they are entitled to something for nothing. they want free healthcare, free education, free social care, free roads, etc. but at the same time they want to have sufficient disposable cash (i.e. low taxes) for the faster car, the bigger house, the nicer holiday, etc. and that for me is the situation which is not sustainable’.

Steve, I have followed some of the debate and tend to agree with most of your conclusions especially the above!
However, I tend to think that the waters are much muddier than many here seem to suggest (in terms of practically dealing with pain and suffering in the clinic). I work as a NHS Physiotherapist primarily in GP clinics , formerly in teaching hospitals with specialist consultants in both orthopaedics and pain management.
Many people like to think that things are scientifically rational and that care is optimised to treat ‘rational people’ with ‘rational’diseases’…..After nearly twenty years dealing with medically unexplained pain syndromes, chronic pain and the ‘no mans land’ between orthopaedics and psychology I can assure most people that a lot of people out there remain a mystery. Sometimes this is due to fragmentation of care , often it is due to a dualistic philosophy perpetuated by outmoded thinking and failure to think of the person in a holistic context.
There does seem to be a lot of Homeopathic bashing and it is an easy target.
Personally, Homeopathy does not interest me that much neither do most ‘modalities’ that get discussed (acupuncture,manipulation etc etc). What I do believe is that there is nothing mere about the placebo or nocebo phenmenon (which clinics are often very good at inducing. For example a lady with a lifelong hx of trauma,’ptsd’ anxiety etc was sent for ‘breathing exercises’ ….the clinic had told her she may need a lung transplant ….this leads to further catastrophisation .
Many people I see are informed that there discs/hips etc ‘are out’ , that they have spines of an old person etc –iatrogenic disability in our inactive society often caused by misinformation is a big part of my caseload. This nocebo situation needs to be understood by many in the medical profession and Benedetti has done some interesting Fmri studies in this area see’When words are painful: Unraveling the mechanisms of the nocebo effect’….Many people seem to need or have been conditioned into expecting help for self limiting problems or problems of living. There is abundant scientific evidence that many common problems can be assisted through ‘self help’ i.e movement restoration , ‘meditation’ or low cost stress reduction techniques. Indeed, I have tried to set these up myself at no cost to patients or the doctors locally…..These measure have not been acceptable and none of the doctors have expressed any interest in coming along or referring patients…..Self management is not a popular option especially if it is ‘free’ —–placebos work much better if you pay for them and they are delivered by a credible hierarchy figure (perhaps I have to wear the bow tie and inject saline for best effects?
I too think that the NHS is the best way to deliver care and also agree that in Scotland (particularly away from the central belt) that the service is largely excellent. However, I sense on a Monday morning now matter how much money you throw at it or doctors that you employ many people will continue to moan or demand more……
I enjoyed Nic Humphrey’s take on understanding the placebo response here (talking with Richard Dawkins).The debate is interesting re self – cure.
www.youtube.com/watch?v=e1AQPue7FEM

“to recognise that for some people homeopathy makes a massive positive difference to their otherwise blighted lives”

No, homeopathy doesn’t do anything. Sitting down with someone who has a sympathetic ear for an hour (rather than the rushed 5 minutes you get with a GP) talking about your problems and the homeopath emphasising and going “Oh, yes” and “I know” makes a massive positive difference to people.

Taking a sugar pill which you think will make you better makes a massive positive difference to people.

Even paying large sums of money to a charlatan can make a massive positive difference to people.

All of these things make people think they’re being proactive about their (self-limiting) condition.

some very interesting points, and it sounds like youve lived a very interesting (but perhaps unlucky?) life having managed to experience several healthcare systems.

re: “everybody in employment contributes to their healthcare costs: about 7% percent of their income is chopped off, and about the same amount of money is paid by the employer”

Im not an accountant but this sounds like tax by another name, with the only difference being that people are aware that a fixed percentage of their pay is being ringfenced for healthcare. The contribution by the employer is tax-deductable, and therefore essentially just tax as far as they’re concerned. Although it may be that increased awareness of healthcare costs has a benficial effect on population usage of the health system with the knowledge that 7% can go up.

“I don’t mind, as long as the waiting is days rather than months, when it comes to suspected cancer.”

This is thankfully something which is changing, with most hospitals running a 2 week wait system for possible cancer cases, and an 18 week system from referal to final treatment, although over 2/3s of cases currently reach this stage within only 12 weeks, and there is moves to reduce this to 9 weeks in cancer.

March 5, 2010 at 8:52 am
Given that for some people it does work where other treatments have not been effective…

The point is that it isn’t “given” at all. Ascribing the effect of real medicine to homeopathic magic water/pills isn’t what I would call “working where other treatments have not been effective”.
Nor is ascribing to a homeopathic effect a normal self-limiting of such types of condition something that can honestly be described as “working where other treatments have not been effective”.

Claims of efficacy don’t constitute evidence of efficacy.

was that M*** in Solihull by any chance? The one that recommends routine US after coil-fitting?

OK, let’s not train GPs to check everything by scans and tests then (it wasn’t my idea, mind you, but some cancer expert worrying about the low cancer survival rates in the UK).
So they can treat depression instead (they are very good at that, aren’t they).
Let’s have more sonographers then!
I don’t mind, as long as the waiting is days rather than months, when it comes to suspected cancer.

Regarding the tendency to early discharge from hospitals after operations. In my experience part of the problem is that when they discharge you, you find yourself in the hands of your GP immediately – that is, once you are out of hospital, the communication between you and the people who know what they have done to you and what is normal, what isn’t is completely halted. I think it is unrealistic to expect GPs to be fully prepared to answer every question that you should be asking the surgeon really. So you find yourself in a vacuum of care (like so often), when you aren’t allowed to speak to the person who could help, and the doctor who is willing to see you can’t help.

Ho-hum.

I’m not German and I don’t live in Germany.

Yes, a bigger percentage of GDP spent on healthcare is one reason. The other one is that the German system is a mixed-funded system: everybody in employment contributes to their healthcare costs: about 7% percent of their income is chopped off, and about the same amount of money is paid by the employer. (It is, of course, more complicated than that, because the Germans make anybody above a certain income or working in certain occupations take out private health insurance etc.)

Of course the German system is not perfect, they too struggle with the increasing costs of healthcare, and also, the element of “let’s just do this extra test and claim the fee for it from the state” is definitely there.

The reason why I mention it is because if you look at the history of healthcare in Britain, pre-NHS the system was more or less trying to be what the German is now. Then, of course, the war broke out, war-time healthcare, poverty, rationing, all sorts of reasons, and the NHS was created. The NHS has always been a very controversial system, partly because financially it never worked, that was very clear after the first one or two years. Since then it has always been about how to make it work without changing the basic idea of it being completely taxation funded and free for all at the point of delivery.

I’m happy that you and your family have had exceptionally good experiences on the NHS. My anecdotes are, unfortunately, not so shiny. I spent a year struggling on the NHS, and it completely destroyed me, both physically and emotionally (but not DIRECTLY financially). It was different hospitals, different doctors, different problems , and I can’t pick out one place or one person, and comfort myself that apart from them, everything must be, surely, fine. To me it seems to be a sick, almost dead system, unbearably slow, unresponsive and superficial. I wish I could have paid some money towards it (or top it up) and got quicker, better care and be back at work quickly to earn that money back.

I think here in Britain we pay a very big price for not wanting to pay for healthcare. Either by contributing directly like the Germans, or contributing by taking out private insurance, or or at least have the choice to top up the NHS costs when we think we need to. I’m not saying we should copy the German system, something that works over there might not work here at all for a variety of reasons. But the longer we wait and the longer we leave it, the more difficult it is going to be to change it.
There is not enough money in the NHS and what there is, seems to be very badly managed. At the same time, patients are not in the customer position, more like beggars at the mercy of whoever seems to be there to care for them.

In my experience, that is.

This brings us back to the beginning to the MP’s report showing that it is placebo pure and simple. So no it doesn’t work. It is just placebo. We know that for a fact. No futher investigation is needed or warranted.

Rather than getting into an ethical debate about whether ends can ever justify means (philosophers have wrestled with this for centuries), I would answer this question in a different way by picking up your comment about doctors prescribing unnecessary antibiotics. Would it be better for all GPs to have sugar pills in their toolkit? When prescribing them, they could simply say “We’re not entirely sure why this works for this kind of condition, but the evidence is that some patients get better after taking them”. That statement would be truthful. It would enable doctors to harness at least some of the power of the placebo effect. And if these pills could be manufactured and supplied very cheaply (no need to dilute and bash against the wall multiple times, no need for dubious marketing or branding, no need for expensive trials), then the patient would not be being exploited for financial gain.

So it would be a cheaper and more honest alternative to homeopathy, and a cheaper and more honest alternative to the unnecessary prescription of proper drugs. But to me the critical point is that it would be a medical professional making the prescription on the basis of what was in the best interests of the patient. So if the patient really would benefit from proper drugs, they would get them. And this is where homeopathy is so indefensible: the fact that homeopaths are selling/prescribing it leads to highly undesirable results. Patients who should get proper drugs don’t get them, and instead pay for sugar pills. Patients who might benefit from sugar pills end up getting expensive proper drugs when they don’t need them, which can ultimately undermine the effectiveness of those drugs.

This is why I don’t think it is true to say that homeopathy is “no better than placebo” – it is far, far worse.

Enders Shadow….I agree with that! A little bit of balance in such matters wouldn’t come amiss.

Cheers.

Sriram

@jwm and DrJG – one anecdote from the US – I worked there for a very short spell and was curious to know why even the most minor of head injuries presenting to the ER got a CT scan. So I asked assuming it was to do with fear of litigation – but it wasn’t. It turned out that the senior ER doctors had shares in the CT scanner and received a “dividend” each time it was used! The joys of a private, for-profit healthcare system

Given that for some people it does work where other treatments have not been effective, it IS rational to divert a very small amount of NHS cash to it. However I would agree that “homeopaths [should not] be allowed to get away with lying about the effectiveness of conventional medicine”, though given how often other groups within the mainstream medical profession do it, there’s no shortage of target for that campaign, and every time that a doctor prescribes an antibiotic to get rid of a whinging patient, they are guilty of the same behaviour

“The take-home message at Bristol [child cardiac surgery unit] came from Steve Bolsin, the anaesthetist who first raised concerns and paid for them with his NHS career: ‘If you want to avoid another Bristol, never lose sight of the patient.’ This is strikingly similar to the conclusion of Robert Francis QC in the Mid Staffs report: ‘If there is one lesson to be learnt, I suggest is is that people must always come before numbers. It is the individual experiences that lie behind statistics and benchmarks and action plans that really matter, and that is what must never be forgotten when policies are being made and implemented.’…..That “new” labour could contrive a culture where £105 billion goes into the NHS at it’s still no safer than bungee jumping, with widespread staff shortages, overcrowded emergency departments, disillusionment and patient harm, suggests that much of our increased funding hasn’t gone where it is needed. Oh, and we’re desperately short of inspirational managers who’ll stick two fingers up at Whitehall and focus on helping their staff to serve their patients.”

“Of course homeopathy is totally fraudulent.
The false claims completely devalue the power of the placebo. Research into the placebo effect is an entirely separate issue and for that we don’t need the label of homeopathy, its history or the nonsense.”

Fundamentalism I’m defining as being willing to assume that the evidence you don’t have will conform to the theory that you are espousing. In this case we see the claim that ‘we don’t need the label homeopathy’ in order to study the placebo effect, assuming apparently that any placebo inducing process is equally effective. THIS IS BAD SCIENCE. The scientific statement is that homopathy is an effective catalyst of the placebo effect for reasons we don’t understand. Until we do, accept the fact that homeopathy is effective in curing some people… Yes it’s uncomfortable for your worldview, but science doesn’t progress if people aren’t willing to look hard at what the BELIEVE.