I don’t see what the problem is with using bullshit in a controlled and safe environment.

The problem is that you can’t tell the patient that it’s bullshit, or it doesn’t work. Lying to the patient about the efficacy of a treatment drives a truck through the concept of “informed consent”. Any treatment which requires a doctor to actively lie to the patient is ethically dubious at best.

“We consider the issue of NICE evaluation important because it ensures patient safety and evidence-based practice. Additionally there is variation in practice across the country with some PCTs funding homeopathy and others not.”

You say this is not necessary, and yet call for all parties to accept the recommendations “in full and without equivocation”. Which is it?

I have to admit to not being ecstatic about Norman Lamb’s second slice of fudge; I think he skips around the subject of placebo entirely. Indeed I think he may actually be responsible for partially proving the homoepathic effect in that the less he opens his mouth, the more effective Lib Dem health policy becomes. But with that caveat aside, I would be very wary of any government implementing a select committee report and bypassing the independent expertise that is available. Select committees are, by definition political creatures. NICE at least aspires to be above all that and, broadly, does its job well (despite what a number of Tories have to say about it). An NICE inquiry need not be expensive and consist of much more than a literature review, but it would be necessary in my view. And I am delighted that the Science and Technology agree with me, in full, and without equivocation.

Why is it separate?

Modern medicine can use radiation, heroin, maggots and any number of other generally harmful substances to beneficial effect. Given that, I don’t see what the problem is with using bullshit in a controlled and safe environment.

Counselling – Not as effective as widely beleived, and certainly not a cure all. Only really works on certain groups (middle-class women) whose “problems” are trivial

Smoking cessation therapty – utter bollocks, funded by the “nicotine replacement” industry with the collusion of govt

Screening – usually not the best use of limited resource – money would be better spend on traetment/research

Big pharma – Is it a coincidence that the rise of big pharma coincided with increasing life expectancy ? Not to be trusted, but then nor are hippy snake oil salesmen…………

That wasn’t quite my point. Of course any form of intervention will cause some kind of placebo effect, it’s just the way that homeopathy is used on the NHS tends to maximise it and to reduce the associated risks (like many things in Britain this is entirely accidental of course).

I agree with you about the danger of the nocebo effect (which is why I aluded to it) but again an NHS homeopath is unlikely to condemn meds like a private and unqualified CAM practitioner would. Taking homeopathy off the NHS would probably only encourage the “evil chemical” vs “good natural” dichotemy that infest the press and magazines and any generalised nocebo effect that that has.

I suspect an awful lot more money is wasted on “go away” drugs from GP’s than what you could rack up on fancy water pills. No doubt the cost of those is inflated after the Laura Ashley wing of Big Pharma have put their mega profit margins on – but that’s an arguement for NHS generics.

If homeopathy goes off the NHS, it won’t vanish. It’ll just be left in the hands of the CAM types who at best are ignorant and at worst dangerous.

You can get a placebo effect simply through reassurance from a doctor. Homeopathy is simply a waste of money. When there isn’t enough money for more needed, proven treatments then funding homeopathy is unethical.

The opposite of the placebo effect is less well known. Called the nocebo effect, it can be just as powerful. How much it is consciously or unknowingly played on by CAM practitioners is an interesting question. If they tell you that conventional medicine is poisoning you and you start feeling ill when you take your meds, is it due to the power of their suggestion causing a nocebo effect?

Its too easy to view CAM practitioners as a bunch of harmless middle-class hippies. In fact it is a multi-million pound industry that has managed to avoid proper regulation. It has ethical skeletons in its closet and isn’t the benign nemesis of Big Pharma it tries to portray itself as.

I and many of my friends have written to the Dept of Health, to ask them to ask NICE to do it. Michael Rawlins (head of NICE) says he is willing to do it if asked, but isn’t allowed to do it on his own initiative. Hence Labour comes out of this controversy far worse than Lib Dems. Conservatives of the Tredinnick stripe simply live on another planet.

The Dept of Health, under Labour, has taken an equally unenlightened view of the best way to regulate things like Traditional Chinese Medicine. They are considering the recommendation of the ghastly Pittilo recommendations at the moment. See, for example, http://www.dcscience.net/?p=2329 It wouldn’t be surprising if they take their customary box-ticking approach, despite that vast body of scientific and medical opinion that it would be silly to give Traditional Chinese Medicine the same status as doctors.

I’d certainly argue that it would be a waste of time and energy for NICE to review the seriously barmy forms of alt med, like homeopathy and distant healing. But I can see the strength of the political argument that it would provide external verification for a policy to remove them from the NHS

Patients are referred to conventionally trained doctors who can and should spot anything serious and get it treated properly (and can be jumped on by the GMC if not). Water is about as harmless as you can get. Side effects, though possible – the power of the mind works both ways – tend to be a lot less; unlike say antidepressants. And as discussed above it’s got to be cheaper than throwing pharmaceuticals down people’s throats.

Like it or not doctors have to deal with a lot of situations where there’s not much they can do: self-limiting conditions, the worried well, vague aches and pains investigated to death, conditions best left alone despite patient demands. If they can say “Go and see Dr Woo the Homeopath – he’s had some success with problems like these”, at worst they’re getting a medical second opinion. At best the placebo effect works its magic charm and the patient feels better.

It may disturb some people’s sense of medical ethics, but given that the most basic ethical rule is “do no harm”, I can’t see how the current use of homeopathy on the NHS fails that.

How about acknowledging the work of Professor Edzard Ernst at the Peninsula Medical School? He’s already done a lot of what Evan suggests. The Lib Dems could simply acknowledge his work and pledge continued support for his department, currently facing closure due to a funding crisis allegedly due to a spat with Prince Charles.

On the question of other parties, Martin and others at the Skeptics Wiki already have that in hand and after Mike O’Brien’s abysmal performance at the SciTech committee, I’ve no doubt at all that the government will be getting very short shrift here when they publish their response.

As regards a general NICE review of CAM, it has to be remembered that a fair number of the so-called therapies that operate under that label can be readily dismissed without the need to waste time and money on a formal review. Before reviewing anything, some consideration needs to be given to the question of scientific plausibility, if NICE is not to become bogged down in arguments over idiotic notions like ‘theraputic touch’ and ‘distance healing’.

I was quite interested by Evan Harris’ response above, as it makes some political sense. If you’re going to tell people that you can’t have it on the NHS, certainly in the current economic climate, then the argument of it not being the most cost-effective manner to get treated has to be the politically correct one to put across.

Yes the first letter was wrong which is why it was withdrawn. But, when you consider how a democratic party makes policy, the actual position as set out in the new position statement is sensible and measured – as James Graham has now described it.

This is because our party has a policy (voted for openly by the representatives at a party conference) on all CAM therapies that are available on the NHS – that is that they should all be reviewed by NICE to see if any cross the cost-effectiveness threshold. Given that homeopathy is not efficacious I am confident that a NICE review will not demonstrate cost-effectiveness.

We called for this years ago.But the current Labour Government has refused to allow NICE to do this whereas under the Lib Dems this would have been done long before the select committee enquiry. Perhaps LC , Unity and David Colquhoun should now concentrate their fire on those parties with either no pollcy or one which seeks to maintain NHS funding of homeopthy without even an examination.

It seems that even in the blogosphere the most sensible position (NICE review of NHS funding) of all the parties gets attacked by both sides!

Evan Harris

Indeed. Why hasn’t Martin criticised the Lib Dems for this? The timing of his article last year was clearly designed to damage the Green Party just before a set of Euro elections they were tipped to do very well in (of course their reasons for not doing so go far beyond what some bloggers on the internet said about them). The woo policies had been there for quite some time, and could’ve been criticised well before the election to give the Greens some time to change, which they have done now. I’d say the timing of this post is a bit unfortunate, given the Lib Dems are getting a lot of mostly good media coverage, but hey ho.

Mat and Alix may well be busy with the conference but I suspect that neither will be particularly enamoured of this particular statement, which is very much the point of this article.

If you’ll recall, the Greens responded very positively to the criticism they got from Martin and have since reviewed their policies and implemented a number of significant improvements.

Having raised this issue, I’d hope that the Lib Dem members/activists who read LC would respond in the same manner and apply a bit of pressure on their own party in support of the SciTech committee’s findings and the excellent work undertaken by two of their own MPs, Phil Willis and Evan Harris.

Martin Robbins is, BTW, very much one of the good guys here and highly respected by other skeptics and science bloggers, myself included.

What you’ve picked up on there is an issue that bedevilled the use of anti-depressants more or less since day one.

While there are some people whose depression does genuinely stem from a biochemical imbalance in the brain, for which drug therapies can be an effective treatment, for many more their issues are purely psychological and would be better addressed using talking therapies.

It is no real surprise, therefore, to find that in many cases the only benefit that anti-depressants confer is that of acting as a placebo.

That said, before we get too far into the business of labelling them as a major drain on NHS resources we need to consider what the costs of providing talking therapies on the same scale might be.

It’s not as straightforward an issue as it might first appear.

I know perfectly well that the placebo effect is anything but irrelevant but, as others have rightly pointed out, the use of placebos raising a number of complex ethical questions that need to addressed properly.

That’s a debate that the medical profession should undertake but its something of a separate issue to the use of homeopathy which is, after all, nothing more than an archaic exercise in sympathetic magic.

No, we just don’t like holier-than-thou fools with a penchant for silly right-leaning nonsense.

Where are Mat Bowles (MatGB) and Alix Mortimer? Normally you can’t mention the Lib Dems without getting attacked as being Labourites byt those two. Maybe it’s because they’re all down at their little conference. I hope Clegg’s Spectator interview and praise of Thatcher went down well!

Two points arise from this. Firstly anti-depressants are, I suspect, a much greater drain on NHS financial resources than homeopathic treatments. Secondly, as the slightly puzzling “mass homeopathy overdose” demonstration showed recently, you can’t harm yourself with homeopathic remedies. However, anti-depressants may not help you, but they can certainly harm you, and an overdose can cause permanent damage or kill you.

So, logically, if prescription of placebo remedies is to be proscribed, then the ban should start with anti-depressants.