Homeopathy as “at best a placebo and a misuse of scarce NHS funds”.

According to Simon Stevens the CEO of the NHS anyway https://www.england.nhs.uk/2017/07/medicine-consultation/. Interesting that some of the biggest advocates of homeopathy include HRH Prince Charles. I mean whatever your view of him, his view should have a loud voice, but it appears not.

In a bid to save money in the NHS, an aim with credibility, although the aim of reducing wastage in the NHS would be more honourable and useful to the taxpayer who funds the NHS. This latest consultation projects a saving of £141m which is a huge amount of money in any language. However, the pay costs alone in the NHS for 2016/17 were £1,781m and prescribing costs £8,535m. Enormous figures, and I agree that all unnecessary expenditure should be reduced and eliminated. But, if these items within the £141m are improving health outcomes for people for whatever reason, be that placebo or real, then is it not well spent and at least as good as prescribing drugs.

So why go after this target for savings now? Are there other areas where money could be saved? Of course there are, health tourism costs an estimated £500m per year, and the government is committed to recovering this yet, barely recovers two thirds of this amount (according to the National Audit Office https://www.nao.org.uk/wp-content/uploads/2016/10/Recovering-the-cost-of-NHS-treatment-for-overseas-visitors.pdf). The amount they are failing to collect is more that this placebo consultant will save in total. I wonder why they don’t improver their efforts in achieving the target, perhaps because it is easier to hit the poor taxpayer than to actually change the systems in place and make them effective.

External consultant fees. Could those be a major drain on the NHS finance? Well, according to the NHS accounts for 2016/2017 they only were £101m that year. Yes that is £101m of taxpayer money going to experts that the NHS has contracted with on top of the salaries paid to the management and senior staff. If you have a full workforce at the senior level, they are supposed to be knowledgeable and talented, they are extremely well rewarded, why do you need to engage management consultants. Surely that is what your senior team should be doing? That leads to the question then, what are the senior management doing, and are they worth the money they are being paid?

So what amount wastage in layer upon layer of management in the NHS. Well if you want an organisation that is paralysed by meetings, groups, and committees, most of whom have no decision making role, then that is a great way to waste money. Usually, the same people are attending multiple groups about the same subject. WHY? Imagine the possibilities if those same people dedicated the same time to improving patient care and experience, how much more time they would have to do the job they are paid for.

Returning to the title, homeopathy is at best a placebo. What is a placebo though? The placebo effect is a pervasive phenomenon; http://journals.sagepub.com/doi/abs/10.1177/0163278703026002002; in fact, it is part of the response to any active medical intervention. https://www.ncbi.nlm.nih.gov/pubmed/12099783 The placebo effect points to the importance of perception and the brain’s role in physical health. The use of placebos as treatment in clinical medicine (as opposed to laboratory research) is ethically problematic as it introduces deception and dishonesty into the doctor-patient relationship. The United Kingdom Parliamentary Committee on Science and Technology has stated that: “…prescribing placebos… usually relies on some degree of patient deception” and “prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS.

https://web.archive.org/web/20120224202602/http://www.parliament.uk/business/committees/committees-archive/science-technology/s-t-homeopathy-inquiry/ So if prescribing placebo is bad medicine, the why have Doctors been doing it and why was it not stopped before?

However, if the placebo effect is part of the response to any active medical intervention, then any medication can have a placebo effect. When a GP prescribes medication for your condition it is largely based on a formulaic process and what the drug companies say the drugs will do. The patient believes they have been given the correct medication to correct their illness, infection, or whatever. At that point surely the placebo effect is taking place with regulated drug medication. If the doctor says it will 7 days to take effect do you expect to feel better after 1 day of pills. No, because your mind has been given expectations, and placebo effects are happening.

So could this be extrapolated to say all medicine is placebo. Absolutely not. But between the extremities of total placebo and emergency medicine (whereby there is no time to recognise the administration of drugs, so no chance for the patient to believe they have been given medicine, lays a chasm where clarity is harder to see. It is here where the arguments are equally valid on both sides, where the passions are great, but there can be no winner to the argument, as for every patient receiving a medical intervention there is no easy measurable way to detect if the medicine worked or if the placebo effect was effective and helped the body fight the ailment on its own.

Ultimately, which side of the debate you are on, will be dependent on your own beliefs, and experiences. However, to remove the choice of homeopathy from those who believe in it and are costing the NHS a lot less that expensive drugs seems more than heavy handed, it almost seems vengeful. Just because we don’t understand how something works, it doesn’t mean it won’t work. If the motivation is just to save money, then so be it, as long as those savings are used to pay for improved front line services for the taxpayers, not more overpaid consultants, quangos and more bureaucracy. Have some courage and look at where the real financial pressures are coming from and where savings could be made?