WHY HOMEOPATHY SHOULD CONTINUE TO BE ROUTINELY PRESCRIBED IN PRIMARY CARE

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1 WHY HOMEOPATHY SHOULD CONTINUE TO BE ROUTINELY PRESCRIBED IN PRIMARY CARE The Society of Homeopaths is the UK s largest group of registered professional Homeopaths. We promote the highest professional standards and our register is accredited by the Professional Standards Authority. Membership of the Society (shown by the letters RSHom) is a guarantee of a well trained, registered and insured professional homeopath. Introduction Backed up by a substantial body of evidence, homeopathy offers the National Health Service and its patients many benefits. Homeopathy is a widely popular therapy, which addresses a host of ailments at relatively low cost and in many cases, homeopathy could ease the strain on the NHS and reduce the use of more expensive treatments. We query the inclusion of homeopathy within this consultation. Most of the items in this consultation are pharmaceutical products, which are used for specific purposes and conditions, whereas homeopathy is a system of medicine, developed over many years, which offers an individualised, patient-centred approach for a wide variety of conditions. It is often used when other options have been tried and failed to resolve the problem. At a time when wellbeing, patient choice and personal health responsibility are given such a high priority, it is odd that NHS England has allowed itself to be bullied by vested interests into publicly advocating cutting a non toxic treatment that is used by so many people within the UK. Patient choice Homeopathy has been part of the NHS service in the UK for over 60 years and is a popular choice for many patients and parents. In 2013 homeopathy was the second most popular complementary therapy in the UK (Watson, Leala KPosadzki, Alotaibi, and Ernst 2013). Orthodox medicine does not meet the needs of every patient (Franzel et al. 2013; Posadzki et al. 2013).The inclusion of homeopathy extends the range of patient choice and supported self-care within the NHS. UK NHS patients come from many cultures and ethnic origins, including those from countries such as India, France and Switzerland where homeopathy is widely used as part of the primary healthcare system. Recommending the de-prescribing of homeopathy on the NHS cannot claim to be in the interests of equality and diversity, and certainly not in the interest of patient choice

2 There is plenty of evidence that homeopathic treatment is not placebo Claims that homeopathy is based on placebo have been largely based on one 2005 meta-study by Shang et al (Shang et al. 2005). There is plenty of evidence from randomised controlled trials demonstrating that individualised remedies show a difference from placebos. Up to the end of 2014, there were 189 peer-reviewed papers, with useable data, reporting homeopathy randomised controlled trials (RCTs). Out of the 104 placebo-controlled trials, 43 (41%) reported positive, 5 (5%) negative and 56 (54%) non-conclusive findings. The most recent systematic review and metaanalysis of randomised placebo-controlled trials of individualised homeopathic treatment found small but consistent effects (Mathie et al. 2017). The recent Swiss Health Technology Assessment of homeopathy found it to be safe, effective and cost-effective and concluded that there was sufficient evidence for the preclinical effectiveness and the clinical efficacy of homeopathy and for its safety and economy compared with conventional treatment (Bornhöft and Matthiessen 2011). Positive results of patient outcome and attitude studies Studies of patients receiving homeopathic treatment on the NHS show positive outcomes for a wide range of conditions. Examples are: One outcome survey carried out at the Liverpool Department of Homeopathic Medicine between 1999 and 2000 surveyed 1,100 patients. 76.6% of patients reported an improvement in their conditions since starting homeopathic treatment, while 52% of patients reduced their conventional medication (Richardson 2001). Another observational study of 6544 patients followed up patients during a 6-year period at Bristol Homeopathic Hospital, with over 23,000 attendances. 76.6% reported positive health changes since starting homeopathic treatment and over 50% reported this as better or much better (Spence et al. 2005). A 2008 pilot data collection study, of 1602 follow up appointments, set out to establish quality assurance, improvement and development across all five homeopathic hospitals in the UK National Health Service (NHS). The findings illustrate the range and complexity of chronic disease managed within the homeopathic hospitals, with eczema, asthma, arthritis, menopausal symptoms and CFS in the top 10 conditions. After a series of homeopathy appointments, a high proportion of patients reported improvements in health affecting their daily living (Thompson et al. 2008). Studies of homeopathy in primary care in other countries show similarly positive results

3 Patient satisfaction can be higher in primary homeopathic care than conventional care. An observational study in Switzerland investigated patient satisfaction and perception of side effects in homeopathy compared with conventional care in a primary care setting (Marian et al. 2008). The study used data from two large cross-sectional studies (over 6,000 patients) conducted in There were significant differences in the initial health status of the groups, with a higher percentage of chronic and severe conditions found in the homeopathic group. The overall patient satisfaction score was significantly higher in the homeopathic care group. The authors concluded that homeopathic treatments were perceived as a low-risk therapy by patients with two to three times fewer side effects than conventional care. Homeopathy has a role to play in the treatment of chronic illness. A recent study using MYMOP* as an outcome measure added to a growing body of observational data demonstrating that patients with long term conditions coming under homeopathic care often show improvement to their conditions (Thompson, Viksveen, and Barron 2016). A 2005 prospective, multicentre cohort study reviewed the use of homeopathy in 103 German and Swiss primary care practices. (Witt et al. 2005) 3,981 patients consulting the doctor for the first time were observed, 97% had chronic ailments lasting on average around 8 years, the most frequent being allergic rhinitis in men, headache in women, and allergic skin conditions in children. The severity of symptoms decreased significantly between the start of the trial and two years. The most significant improvements were seen in the young and those with more severe symptoms. Low cost of homeopathy to the NHS As a therapy, homeopathy represents a low cost intervention. The cost of homeopathic treatment to the NHS is very small - out of the total NHS budget of 100 billion a year, it spends 4 million (0.004%) on homeopathy. The saving of the 92,000 the NHS currently spends on homeopathic remedies would amount to under % of the NHS budget and would almost certainly be negated by the costs involved in seeking to provide other forms of treatment for patients. The use of homeopathy could help to reduce prescriptions of other drugs, including anti-inflammatory medicines. In some cases homeopathy can offer a low cost and low intervention substitute for conventional medicines. In an EPI3 study in France, patients treated with homeopathy for musculoskeletal disorders did as well clinically as those treated with conventional medicine, but used only half the amount of non-steroidal anti-inflammatory drugs (NSAIDs) and had fewer NSAID-related side effects (Rossignol et al. 2011)

4 A strong body of evidence exists suggesting that homeopathy can be effective in both treatment and prevention of respiratory tract infections (URTIs) Patients with URTIs given homeopathy in a four-year population-based study (EPI3 survey) of 825 GPs and their patients in France showed significantly lower consumption of antibiotics and antipyretic/anti-inflammatory drugs, yet their symptoms improved at a similar rate. Data was used to compare the effectiveness of antibiotic and antipyretic/anti-inflammatory drugs with additional or alternative use of homeopathy in 518 adults and children with URTIs. (Grimaldi-Bensouda et al. 2014) Safety issues Homeopathic therapy is seen as integrative rather than an alternative. Side effects of homeopathic remedies are rare. Studies show that homeopathy, when used appropriately and judiciously is a safe therapeutic intervention for a wide range of physical and mental conditions (Bornhöft, Ammon, and Righetti 2006; Del Carmen Macías-Cortés et al. 2015; van Haselen et al. 2016; Jong et al. 2016). * Measure Your Medical Outcome Profile Bornhöft, Gudrun, Von Ammon, and Marco Righetti Effectiveness, Safety and Cost- Effectiveness of Homeopathy in General Practice Summarized Health Technology Assessment. Forsch Komplementärmed 13(2): Bornhöft, Gudrun, and Peter F. Matthiessen Homeopathy in Healthcare Effectiveness, Appropriateness, Safety, Costs. An HTA Report on Homeopathy as Part of the Swiss Complementary Medicine Evaluation Programme. Berlin Heidelberg: Springer-Verlag. Del Carmen Macías-Cortés, Emma, Lidia Llanes-González, Leopoldo Aguilar-Faisal, and Juan Asbun-Bojalil Individualized Homeopathic Treatment and Fluoxetine for Moderate to Severe Depression in Peri- and Postmenopausal Women (HOMDEP-MENOP Study): A Randomized, Double-Dummy, Double-Blind, Placebo-Controlled Trial. PLoS ONE 10(3). Franzel, Brigitte, Martina Schwiegershausen, Peter Heusser, and Bettina Berger Individualised Medicine from the Perspectives of Patients Using Complementary Therapies: A Meta-Ethnography Approach. BMC complementary and alternative medicine 13(1):124. Retrieved ( dertype=abstract). Grimaldi-Bensouda, L. et al Management of Upper Respiratory Tract Infections by Different Medical Practices, Including Homeopathy, and Consumption of Antibiotics in Primary Care: The EPI3 Cohort Study in France PLoS One 9. Retrieved ( van Haselen, Robert et al The Effectiveness and Safety of a Homeopathic Medicinal Product in Pediatric Upper Respiratory Tract Infections With Fever: A Randomized Controlled Trial. Global Pediatric Health 3: X Retrieved (

5 Jong, Miek C. et al Effectiveness, Safety and Tolerability of a Complex Homeopathic Medicinal Product in the Prevention of Recurrent Acute Upper Respiratory Tract Infections in Children: A Multicenter, Open, Comparative, Randomized, Controlled Clinical Trial. Multidisciplinary Respiratory Medicine 11(1):1 13. Retrieved ( Marian, Florica et al Patient Satisfaction and Side Effects in Primary Care: An Observational Study Comparing Homeopathy and Conventional Medicine. BMC Complementary and Alternative Medicine 8(1):52. Retrieved ( Mathie, Robert T. et al Randomised, Double-Blind, Placebo-Controlled Trials of Non- Individualised Homeopathic Treatment: Systematic Review and Meta-Analysis. Systematic Reviews 6(1):63. Retrieved ( Ng, Daniel Yu Hin A Discussion: The Future Role of Homeopathy in the National Health Service (NHS). Homeopathy 100(3): Posadzki, Paul, Leala K. Watson, Amani Alotaibi, and Edzard Ernst Prevalence of Use of Complementary and Alternative Medicine (CAM) by Patients/consumers in the UK: Systematic Review of Surveys. Clinical Medicine 13(2): Retrieved ( Richardson, W. R Patient Benefit Survey: Liverpool Regional Department of Homoeopathic Medicine. 90( r, c6j): Retrieved ( 784). Rossignol, Michel et al Who Seeks Primary Care for Musculoskeletal Disorders (MSDs) with Physicians Prescribing Homeopathic and Other Complementary Medicine? Results from the EPI3-LASER Survey in France. BMC Musculoskeletal Disorders 12(1):21. Retrieved ( Shang, Aijing et al Are the Clinical Effects of Homoeopathy Placebo Effects? Comparative Study of Placebo-Controlled Trials of Homoeopathy and Allopathy. Lancet 366(9487): Spence, David S., F. F. Hom, D. R. C. Og, Elizabeth A. Thompson, and S. J. Barron Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study. the Journal of Alternative and Complementary Medicine 11(5): Thompson, E., P. Viksveen, and S. Barron A Patient Reported Outcome Measure in Homeopathic Clinical Practice for Long-Term Conditions. Homeopathy 105(4):1 9. Retrieved ( Thompson, Elizabeth A. et al Towards Standard Setting for Patient-Reported Outcomes in the NHS Homeopathic Hospitals. Homeopathy 97(3): Retrieved ( Witt, Claudia M., Rainer Lüdtke, Roland Baur, and Stefan N. Willich Homeopathic Medical Practice: Long-Term Results of a Cohort Study with 3981 Patients. BMC Public Health 5. Retrieved ( Society of Homeopaths mark_taylor@homeopathy-soh.org