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OPINION

'Don’t dismiss the role of complementary therapy in healthcare'

Complementary therapies are a valuable adjunct to conventional medicine, argues Dr Charlotte Mendes da Costa

Mark Radcliffe’s article “If only a rub down with rose petals could cure ill health”, which was in response to researchers at Bournemouth University who suggested nurses are best placed to integrate complementary therapy into the NHS, not only highlights the inflexible and entrenched viewpoint of those opposed to complementary therapy, but also their failure to engage in serious intellectual debate on the subject.

While saying he has no wish to give the impression of rushing to judgement, he does precisely that by stating that “most clinical trials seem to suggest that not only do these interventions not work but also there are no such things as elves”. Ignoring his facetious schoolboy humour, this is the argument frequently expressed in the media and medical press - an argument that ignores the facts.

As a GP working in the NHS and a trained homeopath I believe I’m far better qualified to comment on this particular therapy and its usefulness for patients.

“I integrate homeopathy into my practice, using it when I feel it is appropriate for the patient and have seen quite remarkable results”

First, there is evidence supporting the effectiveness of homeopathy. Up to the end of 2010, 156 randomised controlled trials (RCTs) in homeopathy had been carried out with 41% reporting positive effects, whereas only 7% have been negative. The remainder were non-conclusive. Furthermore, four of five major comprehensive reviews of RCTs in homeopathy have reached broadly positive conclusions. No doubt opponents of homeopathy will dispute these figures, but then again these self-appointed arbiters of what is correct clinical practice will dispute any research evidence supporting homeopathy and other complementary therapies.

Mr Radcliffe does concede the popularity of complementary therapy, but then fails to examine the reasons for this popularity. The public are drawn to therapies such as homeopathy because they have found that they work. And after all, people are not stupid; if something is ineffective it quickly loses the public’s endorsement. Patient satisfaction - something all healthcare professionals should be seeking to achieve - is consistently high in surveys carried out at the NHS homeopathic hospitals in London, Bristol and Glasgow.

I integrate homeopathy into my practice, using it when I feel it is appropriate for the patient and have seen quite remarkable results. I have no doubt complementary therapies are a valuable adjunct to conventional medicine and that the people best placed to integrate these therapies into mainstream healthcare are nurses.

Nurses trained in the benefits and appropriateness of different complementary interventions would be able to inform patients of the most suitable therapy for their conditions, be it homeopathy, herbal medicine, reflexology or acupuncture. Just as importantly they would be able to advise patients when complementary therapy is not the best form of treatment and that conventional therapy should be used.

In Europe complementary therapy is even more popular than it is here in the UK and has been incorporated into the health systems of France, Germany and Italy. And while this modern approach to healthcare is anathema to those who have never trained in complementary therapy, let alone used one to treat patients, interest among healthcare professionals is growing.

The benefits that complementary therapy can bring to the health service need to be discussed. Sadly, in using heavy sarcasm to scornfully dismiss complementary therapies Mr Radcliffe misses the opportunity to encourage such a discussion.

Dr Charlotte Mendes da Costa is a GP in Chiswick, west London


Readers' comments (72)

  • I agree with this absolutely, but like I said in another post, I wish 'complimentary therapy' wouldn't be used as an umbrella term for so many diverse treatments. Some of these treatments are absolutely effective and do a lot of good, others not so much, yet by lumping them all in together, the term can often be defined by the ones that do not work.

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  • Absolutely Mike, they cannot all be lumped in as 'complimentary therapies'.

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  • If you are going to present information mendaciously then it will indeed be disputed. Many more than 156 RCTs of homeopathy have taken place and the totality of evidence demonstrates overwhelmingly that it. Notabley, you assert that, "four of five major comprehensive reviews of RCTs in homeopathy have reached broadly positive conclusions". It behoves anyone who makes categorical claims of these nature to provide references. That you fail to do so is unsurprising given what the "four of five major comprehensive reviews of RCTs in homeopathy" actually say.

    Let's have a look:

    1. Kleijnen et al, 1991, meta-analysis, 107 trials.
    "CONCLUSIONS: At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias."

    2. Boissel et al, 1996, critical literature review commissioned by the European Commission Homeopathic Medicine Research Group, 184 trials. Boissel controversially combined p-values of the highest quality trials to arrive at this conclusion:

    "From the available evidence it is likely that among the tested homoeopathic approaches some had an added effect over nothing or placebo….but the strength of this evidence is low because of the low methodological quality of the trials."

    3. Cucherat et al 2000, used the same data as Boissel but with the addition of at least two more trials. Boissel was one of the four-strong research team and authored the report, which concluded:
    "There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies."

    Early in 2010, science writer Martin Robbins quoted Jean-Pierre Boissel, an author on two of the four papers cited (Boissel et al and Cucherat et al), as saying: “My review did not reach the conclusion ‘that homeopathy differs from placebo’,” and pointed out that what he and his colleagues actually found was evidence of considerable bias in results, with higher quality trials producing results less favourable to homeopathy. (See Guardian on-line 5 February 2010).

    4. Linde 1997, meta-analysis, 89 trials.
    "The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic."

    Linde produced a follow-up paper in 1999, which concluded:
    "The evidence of bias [in homeopathic trials] weakens the findings of our original meta-analysis. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality trials… have negative results, and a recent update of our review for the most “original” subtype of homeopathy (classical or individualized homeopathy), seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments."

    Linde co-authored a brief article in the Lancet in December 2005. In it he wrote,
    "We agree (with Shang et al) that homoeopathy is highly implausible and that the evidence from placebo-controlled trials is not robust…"

    Shang et al were, of course, the team who did the fifth major review - the high quality one that showed homeopathy to be worthless beyond placebo.

    I'll leave the last word to Linde, from the Lancet article:

    "OUR 1997 META-ANALYSIS HAS UNFORTUNATELY BEEN MISUSED BY HOMEOPATHS AS EVIDENCE THAT THEIR THERAPY IS PROVEN."

    Amen.

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  • Apologies for loss of text and typ in my first para above. It should read:

    "...the totality of evidence demonstrates overwhelmingly that it is no more effective than placebo. Notably, you assert that, "four of five major comprehensive reviews of RCTs in homeopathy have reached broadly positive conclusions"

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  • Adam Roxby

    I don't think I can add more to the good refutation made by Maria.

    For a more snappy account just search for 'Homeopathy enemies of reason' and see how Richard Dawkins explains the logic of homeopathy.

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  • Regardless of whether complementary therapies are useful or not, should it not be up to the therapist to recommend their own therapies and encourage patients to use them rather than a nurse selling it to the patient?

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  • And again this is the danger of 'complimentary therapy' as an umbrella term. There are may treatments which have been proven not to work, yet there are also many 'complimentary therapies' that HAVE been proven to work.

    It is time to take each treatment/therapy on their own merits.

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  • Homeopathy is effective according to Swiss federal report

    November 19th 2011

    The English translation of the Swiss Health Technology Assessment (HTA) report on Homeopathy will be published in the UK on 30th November 2011. The Homeopathy Research Institute is glad to bring you a taster of the contents of this exciting report.

    The 2006 HTA report on homeopathy was commissioned by the Federal Social Insurance Office (FSIO) within the context of an overall evaluation of Complementary and Alternative Medicines (CAMs). It was written by a team of German speaking academics and edited by G Bornhöft & F Matthiessen of Witten/Herdecke University in Germany.

    Interestingly, the HTA methodology, unlike meta-analyses and systematic reports such as the Cochrane Collaboration, does not just ask the question of effectiveness of a particular intervention, it also addresses the questions of effectiveness of a therapy in everyday use (i.e. real world effectiveness), how it is used, its safety and its cost-effectiveness.

    This report, amounting to 300-plus pages, exhaustively reviews the scientific literature in homeopathy. It summarises 22 reviews, 20 of which show positive results for homeopathy. Four of these showed strong evidence that homeopathy, as a system of medicine, is efficacious. It also finds strong supporting evidence for the homeopathic treatment of allergies and upper-respiratory tract infections.

    Shang et al comparative meta-analysis which appeared in the Lancet in 2005 and was heralded by the Lancet’s editor as “The end of homeopathy” was, according to Bornhöft & Matthiessen, commissioned by the FSIO as a part of this same assessment of CAMs. It was originally meant to investigate the quality of homeopathy trials compared to those of conventional medicine. In the HTA report the authors analyse the Shang et al 2005 study, stating that, “Although we cannot conclude from the previous remarks [about the Shang et al 2005 study] the opposite conclusion - that homeopathy is effective - we can say with certainty that the Shang et al 2005 study does not prove that homeopathy has no effect.” The report also presents the results of the quality assessment of homeopathy trials, concluding that “studies of homeopathy and phytotherapy were of better quality than comparable conventional medicine studies”.

    The Bornhöft & Matthiessen HTA report ends with this statement: “In conclusion we have established that there is sufficient supporting evidence for the pre-clinical (experimental) as well as clinical effects of homeopathy, and that in absolute terms, as well as when compared to conventional therapies, it offers a safe and cost-effective treatment.”

    With the publication of the English translation of the HTA report, we hope that the debate will finally move from the question, ‘Does homeopathy work?’ to the more pressing questions of ‘How does homeopathy work?’ and ‘What conditions can homeopathy treat effectively and cost-efficiently?’.

    ‘Homöopathie in der Krankenversorgung. Wirksamkeit, Nutzen, Sicherheit und Wirtschaftlichkeit.’
    English Title announced as: ‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs.’
    by Gudrun Bornhöft and Peter F. Matthiessen (Editors)

    Author: Alex Tournier, HRI Executive Director
    Translation: Yves Zimmermann

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  • mike said:

    "...there are also many 'complimentary therapies' that HAVE been proven to work."

    Which ones are you referring to?

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  • This may explain why complementary medicine is now included again in the Swiss compulsory basic insurance.

    I hope patients are at least warned by any professional practitioners and have the choice of accepting or refusing it.

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  • michael stone

    Homeopathy might be proven to work, but as someone with a scientific background the idea that a solution of pure water has any sort of modified inherent activity baffles me. That - the idea that ludicrously diluted solutions are somehow the cause of any effect - is the bit which stretches credulity !

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  • "“I integrate homeopathy into my practice, using it when I feel it is appropriate for the patient and have seen quite remarkable results”"


    Dr Charlotte Mendes da Costa.
    I hope that you make your patients aware of this. Isn't up to them whether they consider it appropriate or not?

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  • what type of perks are GPs getting to prescribe homeopathy. this article smacks of arrogance.

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  • Maria MacLachlan has done an excellent job of exposing Dr da Costa's abject failure to interpret the homeopathy CT 'evidence' correctly. However, I think it's important to point out that a CT of homeopathy is futile (and unethical) cargo cult science and all of that 'evidence' is just meaningless noise anyway. Kevin Smith hints at the reasons why that is so in a recent paper in Bioethics:

    http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8519.2010.01876.x/abstract

    (I won't go into the full explanation here but I think it's important that people should understand that such pseudo-research is futile and unethical because of the consequences of the fact that there is really only 'good' CT evidence against a few and a tiny fraction of all (possible) homeopathic 'remedies'.)

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  • I know that my GP in Lewisham wouldn't get away with treating me with homeopathy... thank God.

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  • You can check see if your GP, nurse, dentist, vet, etc believes in the nonsense that is homeopathy here:

    http://www.britishhomeopathic.org/getting_treatment/find_practitioner/index.html

    And here's advice on changing your GP:

    http://www.nhs.uk/chq/Pages/1088.aspx?CategoryID=68&SubCategoryID=158

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  • are doctors on the UK medical register legally permitted to practice homeopathy and other complementary treatments?

    Sadly we had patients in acute medicine whose faith in homeopathy and similar treatments had caused them to delay seeking medical help such as the tragic case of a young man who tried to treat ca prostate in this manner but which had progressed too far by the time he was admitted to hospital.

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  • "if something is ineffective it quickly loses
    the public’s endorsement"

    I find it depressing that someone who has been the whole way through a medical scientific training can use such an utterly fatuous argument to support their position.

    The regular practices of blood-letting and purging were ineffective and neither quickly lost the public's endorsement.

    The Aztecs practised human sacrifice for hundreds of years in the mistaken belief that it was necessary in order to cause the Sun to rise.

    Dr Mendes da Costa's bald citation of the Faculty of Homeopathy's silly count of research papers also undermines rather than bolsters her credibility as a competent commentator. I wonder whether she might venture 'below the line' to comment on my first point and also to tell us what exactly is meant by a "negative" trial in the Fac Homs list. I know a number of us commenting here know the answer. Does Dr Mendes da Costa?

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  • "if something is ineffective it quickly loses
    the public’s endorsement"

    I find it depressing that someone who has been the whole way through a medical scientific training can use such an utterly fatuous argument to support their position.

    The regular practices of blood-letting and purging were ineffective and neither quickly lost the public's endorsement.

    The Aztecs practised human sacrifice for hundreds of years in the mistaken belief that it was necessary in order to cause the Sun to rise.

    Dr Mendes da Costa's bald citation of the Faculty of Homeopathy's silly count of research papers also undermines rather than bolsters her credibility as a competent commentator. I wonder whether she might venture 'below the line' to comment on my first point and also to tell us what exactly is meant by a "negative" trial in the Fac Homs list. I know a number of us commenting here know the answer. Does Dr Mendes da Costa?

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  • "not only highlights the inflexible and entrenched viewpoint of those opposed to complementary therapy, but also their failure to engage in serious intellectual debate on the subject."

    Poisoning the well, fallacious argument. No evidence suggests 'those opposed' have ever failed to engage or conduct a serious intellectual debate. Nice attack based purely on assumption and a differing viewpoint. The same could be said of those that support CAM, only more so, given the fact that the evidence for CAM is so slim on the ground and yet they continue to make special pleading based arguments to support CAM. Like physics, chemistry, biology and clinical trials aren't the right way to study the use of all drugs because CAM drugs are special unlike conventional drugs which are 'scientific' and the only type of scientific drug...
    Yeah I know right!?

    "As a GP working in the NHS and a trained homeopath I believe I’m far better qualified to comment"

    Argument from authority, fallacious, better qualified than the cochrane systematic reviews and meta-analysis or better qualified at reading them?
    The data all says the same thing either way. We all have our own opinions but we cannot have our own facts. This is the second invalid argument made by the author.

    "Up to the end of 2010, 156 randomised controlled trials (RCTs) in homeopathy had been carried out with 41% reporting positive effects, whereas only 7% have "
    Straight from the Royal Society Of Homeopath's website. OMG yes I've been there and I'm also a genius, turns out I'm best ever qualified to comment on this matter. Pow!

    Actually it turns out the ASA have asked ROH to remove this as it isn't substantiated by evidence. Their new page no longer calls homeopathy an evidence based medicine, this changed about a month ago. May have changed again since, but it certainly was a step in the right direction. They don't have the evidence to support the claim homeopathy is an evidence based medicine and counting clinical trials is not how science is done, it is not the correct way to come to a judgement, a meta-analysis is and last I looked 30 out of 36 were negative. 6 had lame conclusions like, the most impressive I read 'homeopathic arnica can help you recover from a cold by up to six hours'.
    Seriously. Six hours.
    Really.

    Ermmm. Yeaaaaah.
    And they still mentioned the poor quality of the trials and inability to come to a definite conclusion due to this....yeah....


    "but then again these self-appointed arbiters of what is correct clinical practice will dispute any research evidence supporting homeopathy and other complementary therapies."

    Yep sure did dispute those figures, because they are misleading. There is little to no good quality of evidence supporting homeopathy to dispute...

    "The public are drawn to therapies such as homeopathy because they have found that they work. And after all, people are not stupid; if something is ineffective it quickly loses the public’s endorsement. Patient satisfaction - something all healthcare professionals should be seeking to achieve"

    Ah the good old argumentam ad populem, wondered when this would turned up. It's fallacious, it's been debunked in the comments already. Early bad medicine, the placebo effect, cognitive biases, logical fallacies...yeah clinical trials, biology, physics and chemistry all say homeopathy doesn't work and yes a large group of people thinking it does could easily be wrong...we know that, hence creating clinical trials which remove as much experimenter bias and patient expectation, regression to the mean and other extraneous variables...
    It's common sense really...

    " I have no doubt complementary therapies are a valuable adjunct to conventional medicine and that the people best placed to integrate these therapies into mainstream healthcare are nurses"

    Actually a recent study conducted in Bristol and published in the journal 'homeopathy' on homeopathy for asthmatics concluded that homeopathy added no benefit to patients. In fact they concluded that such a trial should never be attempted again due to costs and risks.
    The homeopaths (not at all skeptics) that conducted the study found the homeopathy had no benefit on objective measures and no benefit on subjective measures, not even a placebo benefit, at a cost of £600 per patient. On the NHS. For now benefit. There were also additional costs of patients and parents needing to days of work, travel etc. in order to get to the extra consultation they needed with the homeopath. They didn't use any less conventional medication or usual services.

    Homeopath cost assessment = no benefit for £600 extra per person.
    This is not justifiable.


    "In Europe complementary therapy is even more popular than it is here in the UK and has been incorporated into the health systems of France, Germany and Italy."

    Again this argument by population is absolutely useless in discovering whether or not a treatment works. Indeed whilst the population may have allowed more misleading advertising in those countries and lacked the patient protection we have here, the science is still the same.

    E. Ernst used to believe in homeopathy and work in Germany where homeopathic use is prevalent. He become the worlds first professor of CAM here in the UK and after conducting a number of good clinical trials discovered much to his dismay the lack of efficacy for a number of CAM treatments. He is now an outspoken skeptic, highlighting the ethical issues of prescribing medicines which cannot and do not work. Highlighting the issues in persuading something so pseudoscientific could work, and consequences when they discover this is untrue, that there is no evidence or when they believe it is true and mistrust the science.

    Indeed one piece of research discovered those with cancer who use alt med in the past tend to delay treatment when diagnosed and in that time serious progression is made with their disease.

    Choosing homeopathy to treat cancer is like choosing a sock over a condom as a contraception. Except less useful.

    I find this article about homeopathy to be little more than an advert for a purely marketing based 'treatment'.

    Indeed, a triumph of marketing over science as someone once said...

    For that reason I find it highly irresponsible, unreasonably biased, misleading to the public, nurses and other health professionals and on the whole generally unacceptable.

    The NMC requires all nurses provide the best evidence based treatment. Take this article at face value and you could find yourself in a very awkward position. Be careful, that all I'm saying.
    They do offer a loophole, allowing nurses to recommend CAM or practice it, as long as in their adverts they don't advertise themselves as a nurse and the nurse has to decide that the training or practitioner is adequate.

    All this really suggests is that the NMC wants nothing to do with CAM whilst not making a decision either way but leaving all the responsibility (and blame if anything goes wrong) on the nurse themselves.

    The evidence suggests to me that homeopathy is the best interests of no-one but the person making a profit from selling it.

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