It hardly seems possible that so much has happened since I first started writing about the deteriorating situation in the UK. It’s not possible in this short article to do the subject justice, so I’m limiting myself to a thumbnail sketch of the latest news and a little historical context from the last three years. If you’re interested in reading more I’ve written fully referenced articles about the subject; who the players are; how it all fits together, and the possible implications for CAMs in general. I have included some excerpts from the articles in this piece, but you can download the full articles as pdfs at the end of this discussion.

Homeopathy: Edzard Ernst’s delusion.

Professor Edzard Ernst is the UK’s first university Chair of Complementary and Alternative Medicine (CAM) who, in a few short years, has gone from a self-confessed user of homeopathy to one of its biggest critics. The more Ernst has criticized homeopathy, the more respect he has received from his peers and the higher his profile has become. The UK media now refer to him as the world expert on the scientific evidence for CAMs, “faith-based medicine” has become a descriptive for CAMs in general and homeopathy in particular and the convention for the critics to refer to the ‘delusion’ of homeopathy.

It’s more comforting to think that the current situation has evolved via a series of random if unfortunate events, but I have traced the sudden escalation of the anti-homeopathy movement since the coup that was The Lancet’s “End of Homeopathy?” issue of August 2005. It’s my opinion that there is organization and an orchestration to the timing of events – and that it is another aspect of a much larger anti-CAM legislative trend that seems to be gaining ground.

The Royal London Homeopathic Hospital, an international touchstone for homeopathy and the UK National Health Service (NHS), where homeopathy has been sanctioned since 1948, was the perfect place to start. That provision of homeopathy on the NHS would be seen to be withdrawn, not because of lack of funding, but because it had been proven not to work, could be guaranteed to have far-reaching effects on the rest of the homeopathic world.

Having said that, I also think that there has never been a more exciting time to be a homeopath! The recent changes and challenges present the biggest opportunity that the CAM world, and homeopathy in particular, has had for maybe a hundred years.

As a profession we are being called to step up to the plate, to take ourselves seriously and to walk our talk. We need to be informed, to stay informed and to collaborate on pro-active responses. This is not a time for keeping our heads down and hoping we won’t be noticed. This is a time for Big Ideas and Bold Action! (BIBAs)

Some background: A coup of the highest order

“The End of Homeopathy?” issue of The Lancet, August 2005 included: the infamous fundamentally flawed Shang et al. meta-analysis, which purported to “prove” once and for all that homeopathy is no better than placebo; an anonymous editorial, “The End of Homeopathy”, which implored doctors to be “honest with patients about homeopathy’s lack of benefit”; and a fierce criticism of the leaked pro-homeopathy World Health Organization (WHO) draft report, which was later withdrawn for revision and to date has still to be published.”

Shang et al. took 110 trials of homeopathy that matched the study’s criteria but drew the conclusion for the meta-analysis from just eight of the trials — and in the published paper, neglected to identify the eight they had used! At the insistence of the homeopathic medical community, the eight trials were eventually revealed, and it was easy to understand why they had not been identified. Extreme “cherry-picking” had transpired; only these eight particular trials would produce a negative result and a meta-analysis using other combinations of the 110 trials available would all weigh in favor of homeopathy. (To see just how flawed the “science” is, see the “Proof against homeopathy does in fact support homeopathy”, a detailed critique of the Shang paper (3); and “The growth of a lie and the end of “conventional” medicine”, by two Italian physicians, which lays out the vested interests at work (4) in the full Similia article.)

Needless to say both Shang and Richard Horton, editor of The Lancet, are openly critical of Homeopathy and Shang was part of the group who provided another highly criticized meta-analysis which led to the withdrawal of homeopathy from Swiss health insurance.

The WHO report which described homeopathy as the world’s fastest growing modality, now used by some half a billion people, was leaked by Renckens, a gynecologist and chair of the Dutch Union Against Quackery and another vocal critic of homeopathy. Professor Ernst, Chair of Alternative and Complementary Medicine at Exeter University (as late as 2003, a supporter of homeopathy) called for the report’s revision including a full disclosure of names of authors and any conflicts of interest. In an interesting Freudian slip, the same Lancet article states: “Renckens argues that it is wrong that such reports should not be prepared in secret behind closed doors...” (my italics). The irony surely won’t be lost on the homeopathic community.

The Lancet put out a disingenuous press release describing the meta-analysis as having reviewed all 110 trials to draw the conclusion that homeopathy performed no better than placebo. This conclusion, promoted by critics and media alike has now been accepted as fact. As we say in mathematics: homeopathy = placebo Q.E.D. (point proved) so no further discussion is necessary.

Following the August issue of The Lancet and in a series of apparently unrelated yet perfectly timed events in different formats, high-ranking medical professionals in the UK demanded that public money not be spent on an ‘ineffective, impossible, implausible’ therapy. Strategically leaked reports; letters from 13 of the U.K.’s most eminent medical professionals to funding Primary Care Trusts (PCTs) across the nation, insisted that they stop providing homeopathy as a patient option; and a plethora of newspaper articles served to keep homeopathy in a negative spotlight.

Predictably, the Shang meta-analysis quickly became the defining proof of homeopathy’s ineffectiveness, while the dilution issue continued to make it “scientifically impossible” and the subject of derision. The critics claim they merely want evidence, but what has become clear is that when the evidence they call for has been provided, they claim it scientifically impossible (on the basis of Avogadro’s number) and dismiss it!

In June 2006, the BBC conducted a “sting” of homeopaths for its TV program News Night, exposing the “threat to public health” posed by homeopaths who suggested homeopathic prophylaxis for malaria. Simon Singh at Sense about Science, an openly anti- CAM organization established to “educate the public”, led the sting in which a reporter posed as a patient and asked for homeopathic advice about protection against malaria for a forthcoming overseas trip. The media had a field day. (Several of the major drug companies are listed as funders of this group.)

The main critics began to describe homeopathy variously as: “like drinking a glass of water” (Ernst), “gobbledy gook” (Professor Colquoun, high ranking pharmacist) “worse than witch craft” (Professor Baum, leading oncologist and professor emeritus of surgery). Many of the published articles are astonishing in their ignorance of homeopathy and ferocious in their attack.

In November 2007 enough signatures were finally collected to table a parliamentary debate about the provision of NHS homeopathy. In the same month The Lancet put out another anti-homeopathy issue with three articles, two without a single reference, all slamming homeopathy.

You might be well advised to check your blood pressure before reading some of the most frequent writers. It’s important not to take it personally but to be reassured we are in good company: imagine Hahnemann facing his opposition, he was in the company of one! Let’s be true to our healing philosophy, employ our unprejudiced observer and feel compassion for the opposition’s confusion and fear. The very bedrock of their belief system must change in order for them to embrace homeopathy.

Who are these people?

I have researched the main critics in this movement and found them to be a small but powerful and media savvy group, closely related not least by their common anti-CAM stance. They take turns to write inflammatory articles, to quote each other, endorse each other, award each other prizes and then use them to add authority to their writing. All are connected directly or indirectly with Quackbuster organizations. Some, it seems, have made it a badge of honor to engage unsuspecting homeopaths in apparent debate, only to use the homeopath’s own arguments in ridicule against them. (A serious downside of online debating is the risk of a typo that leads to an ambiguity of meaning. If we are to do it we need to write with precision, with every word considered. I recommend taking a deep breath before drafting your response outside the Comment box, cut and pasting it into the box, re-reading it from their point of view and taking another deep breath before pressing Send.)

Have you heard the one about the homeopath who…….

Ben Goldacre writer for The Guardian and blogger on his website badscience.net has been one of the most prolific critics. He has a band of supporters who seem to have nothing more to do than indulge in ridicule and tired old jokes about homeopathy, clearly a subject they know nothing about, every time Goldacre has an article published. He positions himself as an innocent defender of the gullible public, while he delights in disparaging CAMs, with special ridicule reserved for homeopathy.

Reading any of the writing by Goldacre, Ernst et al is an education in how to use the media. They are careful to include apparent criticism of allopathic medicine, while maintaining a fundamental difference. When writing about homeopathy, the entire system of medicine is condemned. When writing about allopathy they focus on the drug that has proved problematic, ineffective or dangerous, offering their article as an example of their balanced reporting. The allopathic system itself is never held accountable. (The irony when drug recalls have never been more frequent and iatrogenic disease is now, in some reports, the leading cause of death in the US.)

We can be reassured that the strongest criticism leveled at homeopathy remains that homeopathy is placebo and therefore homeopaths are duping the gullible public, and the biggest danger that homeopathy poses, is that patients may waste time valuable time visiting a homeopath, when they should be consulting with an allopath.

2008 has seen two books published in quick succession, the titles of which might lend a clue to their contents. Rosie Shapiro a well-known journalist wrote; Suckers. How Alternative Medicine Makes Fools of Us All. (publisher Harvill Secker). The book is described as a “vigorous polemic” by The Guardian and in The Independent: “The ferocious assault on the evidence-free mountebanks who peddle alternative medicine, and the dupes who fund them, is a bracing tonic...”. Presented as a necessary calling to account of the CAM world, it paved the way for the “scientifically credentialed” Trick or Treatment? Alternative Medicine on Trial by Edzard Ernst and Simon Singh, of News Night sting fame (Bantam 2008). A brief search of the internet reviews will provide examples of the kind of negative conclusions they draw and the extent of the authors bias and / or ignorance. The titles alone are enough to deter the timid from admitting that they use CAMs!

There is a trend

There is a legislative trend in process most clearly illustrated by Codex Alimentarius currently setting regulations governing CAMs in the European Union. Codex is charged with setting the standards for everything regulated under the definition of food. Given the intensive lobbying in the regulating committees, the underlying concern must be who is actually setting the standards and why. Using something called the Precautionary Principle, together with risk assessment, Codex has the means by which to restrict public access to, for example, nutritional supplements. Vitamin C will be restricted to 50mg doses for public sale with higher doses needing a medical prescription and – in order to lessen risk since they can be more easily standardized - limited to synthetic versions and manufactured by the pharmaceutical industry. The required registration of products and product ingredients are now prohibitively expensive for all but the largest manufacturing companies. Although Codex is described as voluntary, it is tied to the World Trade Organization and trading pressures can be brought to bear when necessary. The Alliance for Natural Health, a small UK non-profit organization is successfully challenging Codex all the way to the European Court and shows it’s still possible for David to take on Goliath. (www.alliance-natural-health.org) If you have not taken a close look at Codex, you should, it’s an excellent example of the trend in regulations governing consumer access. (See the article Magnus Pharma in Similia.)

Bill C-51 currently before the Canadian parliament is another good example.

Changes in terminology (“drug” changed to “therapeutic product”) would allow the widest possible interpretation. The Bill also provides for a radical extension of the powers of enforcement, and shifts the decision making power away from elected officials to administrators behind closed doors.

In the US a similar trend can be seen in the Bills advocating mandatory vaccination schedules. That such schedules are to be decided by unelected committees in closed meetings, at a time when cases of vaccine damage are before the courts, makes no rational sense to anyone not tied to pharmaceutical profits.

In the UK the decision to withdraw funding for provision of NHS homeopathy has been given to non-medical administrators in PCTs. The overall trend is towards increasingly restrictive legislation in relation to CAMs and towards diminished public involvement in the decisions which directly affect its health.

Current situation in the UK

Sadly the Royal London Homeopathic Hospital is still waiting for the final word on its future. What once occupied an entire building is now reduced to just one floor, and that shared with other CAM practitioners and their support staff. PCTs are afraid to allocate funding to a therapy they have been told “doesn’t work” in an NHS that is strapped for cash. The fact that the combined budget for the hospitals is $20 million in an NHS budget of almost $200 Billion, and further that the hospitals balance their budgets (almost unique within the NHS), seems to have little effect.

Tunbridge Wells Homeopathic Hospital was slated for closure in March 2008 but a concerted effort by patients and their supporters won the hospital a one-year reprieve. Bristol and Liverpool are still functioning, albeit as small outpatient clinics in separate buildings. Referrals from GPs have been made more difficult and/or refused funding, and in a great example of circular thinking, the consequent reduction in referrals has been used as confirmation that there is no public demand!

To call any of these facilities “a hospital” now is really a misnomer. Gone are the full service facilities with in-patient beds, all are reduced to a series of outpatient clinics.

The Glasgow Homeopathic hospital alone is active and well supported by the Scottish NHS and GP referral service after a strong grassroots lobby secured their position.

New UK government funded CAM regulatory body

A new Complementary and Natural HealthCare Council (CNHC) will begin regulation of CAMs in summer 2008. Although voluntary, it will set standards for a number of CAMs, including homeopathy. The homeopathic profession was not consulted but the professional bodies are confident that their own standards already exceed those set by CNHC. I wonder if allowing a government funded body to set standards is a potentially dangerous precedent in the current climate? In a country with an NHS, CAMs always suffer when economic pressure makes itself felt, so it may just be coincidence that as the negative press has escalated, practitioners have reported a drop in new patient bookings. In the same way, a drop in the number of new students may reflect a population less willing to risk a career change, and afraid that by the time they are trained there may not be a profession to join!

The professional homeopathic societies are busy organizing media responses and conferences and if nothing else, have seen a healthy increase in their membership.

The British Medical Journal has started an open access online journal for submission of cases from any area of healthcare. It's a wonderful opportunity, but to take advantage of it we must be rigorous in our case write ups: write according to the BMJ convention; discuss all the possible variables that might have contributed to the patient's improvement; use the cautious language of research; offer it as information rather than definitive proof, and check grammar and spelling. It's a time for us to take ourselves seriously and step up to the plate. Perhaps homeopaths who are used to writing in this way can offer help to homeopaths who are in the process of learning this skill.

Beyond the crisis

I believe that homeopathy has the potential to fundamentally change this world for the better. Holding the vision of a healthy world in which homeopathy is mainstream medicine is important, but a vision will not manifest without action. The homeopathic community must consciously prepare for this change; and events are moving very, very quickly. Big Pharma is caught up in a global shift in which it cannot survive in its current form. Having engineered its own demise, in its fear and panic it is lashing out.

We need to keep our eye on the ball and our focus on excelling at what we do best, so that we can move into the vacuum that this healing crisis will create.

Let’s not be defensive or angry. Let’s be assertive and most importantly, let’s be fearless. We know the cost of living in fear and the dangers of trying to compromise to the middle ground. We know we have a phenomenally effective medicine, one that the world needs now more than ever, and we should hold to that truth. To be alive during such a fundamental shift and to be on the side of a healing modality that works is just the most wonderful place to be! Rest assured: although it may not feel like it, our time is now and the future is ours.

It seems clear that the progress that has been made to preserve services is as a direct result of grassroots pressure. The NHS is after all a business and what the consumer wants will be provided. H:MC21 is actively building a grassroots campaign – no matter where you are, check out their website and see how you can get involved. www.homeopathyworkedforme.com)

This is no time for keeping our heads down. It’s a time for Big Ideas and Bold Action (BIBAs). News about a BIBA coming soon!

For in depth reporting on these issues and more, please see the articles by the same author published in Similia:

Magnus Pharma and the Golden Goose, Similia Vol 19 number 1 June 2007

Science Catches up with Homeopathy, Similia Vol 19 number 1 June 2007

Homeopathy and Humbug, Similia Vol 19 number 2 Dec 2007

Homeopathy – the ultimate delusion, To be published in Similia June 2008

-----------------------------------------------------------------

Carol Boyce BSc, MCH, CCH, RSHom(NA):

homeopath, teacher, writer, activist, filmmaker.

Carol was writing up her PhD thesis at London University when she found the Life of Hahnemann on a library shelf and the rest, as they say, is history. She graduated from the College of Homeopathy, London, England in ’85; has taught homeopathy since then both in the UK and the US; is on faculty at several US schools; has developed the 30-hour Distance Learning video program in Philosophy for the American University of Complementary Medicine’s PhD Homeopathy program.

In the early 90’s Carol took homeopathy to Iraq after the first Gulf War; co-founded the non-profit Homeopathy For a Change, fore-runner of Homeopaths Without Borders (HWB) UK; set up teaching / clinic projects from Calcutta to Cairo; taught in medical schools in Cuba and was executive director of HWB US in 2002.

Since 2004 she has also been Director of Education for The Homeopathic Symposium, a website offering interactive online clinical training and a video archive of cured cases.