One Down, Four To Go...
The NHS in Kent have stopped funding the Tunbridge Wells Homeopathic Hospital, which leaves four NHS-funded homeopathic hospitals. This is, of course, a good thing: homeopathy is (and let’s be fair to it) total bollocks, and while there’s nothing particularly wrong with homeopathic hospitals existing*, giving them public funding is quite indefensible. Apparently, the decision was taken because “the NHS has to decide the best use of money on the evidence of clinical effectiveness”. This is also good – homeopathy has no clinical effectiveness and therefore should get no money. But I can’t help feeling that all of this is not so much a good thing as it is a very, very small step towards a good thing. The ideal situation is that public money isn’t spent on irrational things. It may come as a shock for many people, but I have checked, and we are not living inside a Jasper Fforde book, and here in Real Life there’s no reason to spend public money paying deluded people to put bad medicine into beakers and then repeatedly rinse them out, just like there’s no reason to spend public money brainwashing vulnerable children into believing in God.
Okay, so the NHS in Kent have decided that homeopathy is at least a little less deserving of funding than the other things they’re doing, but that’s not the same as the NHS stopping spending my money on stupidity. The NHS still seems pretty supportive of homeopathy. They know it’s nonsense, of course, everyone know that (or at least, everyone who counts), but they support it anyway. Why? Because a very tiny fraction of the public want them to. This is what the NHS has to say on its homeopathy information page:
Around 200 randomised controlled trials evaluating homeopathy have been conducted, and there are also several reviews of these trials. Despite the available research, it has proven difficult to produce clear clinical evidence that homeopathy works. Many studies suggest that any effectiveness that homeopathy may have is due to the placebo effect, where the act of receiving treatment is more effective than the treatment itself. Medical doctors and scientists do not generally accept homeopathy because its claims have not been verified to the standards of modern medicine and scientific method. Scientists argue that homeopathy cannot work because the remedies used are so highly diluted that in many there can be none of the active substance remaining
That, to me, reads as a pretty damning condemnation of homeopathy**. It’s cagily worded, saying “it has proven difficult to produce … evidence” rather than flatly stating that there is no good evidence, but it’s pretty clear in its message: the people whose job it is to know if things like this work generally agree that it doesn’t. And yet this is on the website of the NHS, a body who spend a million pounds on homeopathy every couple of months. So why do they do that?
I think the government lately has taken to trying to appeal exclusively to minorities. A small number of people want magic water on the NHS, so they get it. A small number want faith schools, so they get it. They held out on the smoking ban for as long as possible, presumably to please the small number of smokers in the public (although the quite bare-faced exemption of the House of Commons’ bar suggests another motive).
Of course, it doesn’t help that MPs are basically all rubbish at science. The above link is to a transcript of a debate in the House of Commons. Here’s a paragraph, spoken by David Tredinnick, whoever he might be:
Surveys have been done to see whether the treatments are effective. The Bristol homeopathic hospital did an outcomes study, not just of a percentage of its patients, but of the lot. It surveyed 6,544 consecutive follow-up patients, and the outcomes scores were as follows. They had all taken homeopathic medicine, and they were asked whether it worked. Seventy-one per cent.’”three quarters’”said that they had improved, half said that they were better or much better, and homeopathy was associated with positive health changes to a substantial proportion of a large number of patients with a wide range of chronic diseases. In other words, cutting out the jargon, the hospital was treating lots of different people for lots of different things’”lots of serious problems.
He’s citing a survey as evidence. Which would perhaps be fair enough if there was any kind of a placebo control group – without knowing what kinds of conditions were being treated and how those conditions generally respond to placebo, without knowing what I’m supposed to understand from “71% … said they had improved, half said they were better”, without knowing what “a substantial proportion” might be, this is just a bunch of meaningless statements. I can see that at an idle glance at that paragraph. It worries me if the people running the country can’t. He mentions some numbers from other trials later, but to be honest I’ve already lost faith in his ability to understand scientific studies so his summary of them is of little value to me.
And of course, one might argue that they shouldn’t be expected to; that they’re politicians, not scientists, and that it’s unreasonable to demand they know how to critique a scientific study – they have advisors for that. And that would be true if they weren’t discussing NHS policy. NHS policy has to be decided by people who understand medicine; that’s just common sense. And anyone who thinks that a survey performed by a homeopathic hospital with no control group is in any way useful evidence does not understand medicine and shouldn’t be given a say, elected official or not.
Another thing which annoys me is that while I was trying to find out how much the NHS spends on homeopathy I found many references claiming that it costs 16p to treat a patient. Now I don’t know what that’s meant to mean, but it’s a lie. A glass of tapwater costs effectively nothing, and no molecules of medicine costs exactly nothing. But the whole placebo shebang costs a lot more – you have to pay someone to sit and talk to a patient for ages before they’re sufficiently bored that the ‘medicine’ will have any effect. They say it costs 16p. The BBC article I linked at the beginning says that the hospital in Tunbridge Wells costs £160,000 a year and treats 1000 patients with that money. That works out to £160 a year, which is a thousand times what is being claimed.
Apparently, the NHS has been funding homeopathy since it was founded, and it still is. You celebrate this one hopsital closing if you want, but I don’t call that progress.
- I think it’s fair enough to provide a market for anything people believe, although if the homeopaths say that their medicine is more than just a placebo, as I’ve seen homeopaths do quite explicitly, then of course that’s fraud (even if it does make the placebo more effective – these morals are pretty clear cut when it’s not your money you’re spending, as in the case of the NHS spending money that the general public has worked to provide). And if a patient has nothing wrong with them then it’s just about acceptable for a GP to suggest they try alternative therapy, although obviously the NHS mustn’t fund that. If we’re happy for the NHS to lie to us in what it sees as our best interests, then how can we complain when ministers do it? <hr />** Here’s some example questions from the “what to ask” section of that same page (emphasis mine). I think there’s some pretty good advice here:
- How effective is this treatment?
- How will I know if the treatment is working?
- What will happen if I don't have any treatment?
- Are there any other ways to treat my condition?
- Can you explain it again? I still don't understand