COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
OFFICIAL REPORT
(Hansard)
Homeopathic Medical Services
11 December 2008
Members present for all or part of the proceedings:
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Mr Alex Easton
Mr Tommy Gallagher
Mr Sam Gardiner
Mrs Carmel Hanna
Mr John McCallister
Witnesses:
Dr Sara Eames ) Royal London Homeopathic Hospital
Dr Peter Fisher )
Mrs Audrey Kerr )
Dr Kenneth Kerr ) Faculty of Homeopathy Northern Ireland Branch
Mrs Kathleen Savage )
Dr Gary Smyth
The Deputy Chairperson (Mrs O’Neill):
I welcome representatives from the Faculty of Homeopathy, who are here to give evidence on NHS homeopathy services. A copy of the faculty’s ‘Business Plan and Proposals for a Northern Ireland NHS Homeopathy Service’ is included in Committee members’ packs.
I know that the witnesses have had a difficult journey to get here, and I am glad that they have made it. I welcome Dr Peter Fisher, who is clinical director of the Royal London Homeopathic Hospital; Dr Sara Eames, who is president of the Faculty of Homeopathy; Dr Gary Smyth and Dr Kenneth Kerr from the Faculty of Homeopathy Northern Ireland Branch; Mrs Kathleen Savage, NI regional representative for the Faculty of Homeopathy; and Mrs Audrey Kerr, liaison officer for the Faculty of Homeopathy Northern Ireland Branch.
Dr Gary Smyth (Faculty of Homeopathy Northern Ireland Branch):
Thank you for waiting for us; it is much appreciated.
I thank the Committee for inviting us here to discuss our proposals for the introduction of an NHS homeopathy service in Northern Ireland. I will highlight some key issues, most of which are covered in our submission. I will talk about three key themes: a background to who we are and why we are today; a background to homeopathy; and a background and brief introduction to our proposals for Northern Ireland.
Since its inception in 1948, the NHS has provided homeopathy services in the rest of the UK. Those services are provided at the five NHS homeopathic hospitals, in Bristol, Glasgow, Liverpool, London and Tunbridge Wells. There are several other homeopathic satellite clinics outwith those hospitals. In this, the sixtieth year of the NHS, Northern Ireland remains the only UK region without homeopathic services available to patients on the NHS. That inequality has led to a postcode lottery for homeopathic services — people born in Belfast or Lurgan, rather than in Bristol or London, will not receive homeopathic services on the NHS. That is a huge problem that we want addressed in the year of the sixtieth anniversary of the NHS.
Although Dr Sara Eames may speak a little about the Faculty of Homeopathy, I will provide a brief background to the organisation. It was incorporated by an Act of Parliament in 1950 to oversee and train doctors in homeopathy, and it remains the only body in the UK for that purpose. It has more than 1,400 members, most of whom are doctors, nurses, pharmacists, vets and other healthcare professionals. Each member of the Faculty of Homeopathy practises homeopathy in the bounds of their profession, and that is very important. Each member is suitably trained and qualified, not only in conventional practice but in homeopathy. Members of the Faculty of Homeopathy are the only homeopathic practitioners who are statutorily regulated in the UK.
As we discussed over lunch, this is not the first time that the Faculty of Homeopathy has been before a Health Committee of the Assembly. Dr Kenneth Kerr and Dr Peter Fisher appeared before it in the 1980s, and the then Health and Social Services Committee presented its report to the Assembly at that time. The Assembly recommended to Mr Douglas Hurd, the then Secretary of State for Northern Ireland, that an NHS homeopathy service be established; that medical students be introduced to homeopathy in their undergraduate curriculum; and that the department of pharmacy at Queen’s University be funded to set up a homeopathic research facility.
Partly owing to the political problems of the time and the subsequent collapse of the Assembly and a return to direct rule, those recommendations were never implemented. We are grateful to have another opportunity to have such a service established. In summary, this is not new ground, and we have been here before.
There is often much confusion about what homeopathy is. Homeopathy is a very popular system of medicine — a system of therapeutics — that aims to stimulate the body’s natural immune response. It is based on the principle of like curing like. At lunchtime, we talked about some examples whereby symptoms can be treated using a medicine prepared from a substance that would actually cause similar symptoms were it administered to a healthy person. Homeopathy takes an holistic, whole-person view of the patient. It assesses a person’s symptoms and how those symptoms affect that person’s life. A homeopathic medicine is selected and given to the patient based on the totality of the symptoms and how that person is suffering from those symptoms.
All homeopathic medicines are prepared and provided by recognised homeopathic pharmacies, and they are all prepared under a special manufacturing licence from the Medicines and Healthcare products Regulatory Agency (MHRA). It is also important to point out what homeopathy is not. At lunchtime, we mentioned that homeopathy is distinct from herbal medicine. It is not herbalism, mineral supplements or vitamin supplements that people can buy a vast array of in shops. Homeopathy is a distinct entity and specialty in its own right.
Homeopathic medicine is very safe. Under the supervision of an appropriately qualified and regulated practitioner, it can be used by people from the youngest age through to older people, pregnant women and nursing mothers. Although homeopathic medicines are safe in the hands of suitably qualified practitioners, there is a risk should people be treated by those who do not have adequate training in, and knowledge of, the speciality. In such cases, there is potential for misdiagnosis, mistreatment and, significantly, a lack of awareness of when conventional treatment is required and when homeopathy should be used.
Homeopathic medicines are very inexpensive. Our submission — ‘Business Plan and Proposals for a Northern Ireland NHS Homeopathy Service’ — presents evidence to suggest that homeopathy has the potential to reduce the prescribing budget and to generate considerable savings for the NHS. That evidence is contained in pages 27 and 28 of the document. Some studies have also shown that homeopathy can lead to a reduced number of GP consultations and that doctors who prescribe homeopathy issue fewer prescriptions, and at a lower cost, than their colleagues. Therefore, there is potential to generate considerable savings in the prescribing budget.
The costly downward spiral of specialist opinions and ongoing investigations for many patients in conventional care can be interrupted when a whole-person approach is taken and when homeopathy is the first-choice therapy. The cost of poor health is huge, and it seems to be spiralling completely out of control. By comparison, the cost of homeopathy is very small.
There is clear evidence that homeopathy has a beneficial effect beyond that of placebo. Our briefing pack includes a comprehensive summary of the research that has been undertaken on homeopathy. I shall not go into detail now, but we may have a chance to discuss that matter later.
Up to the end of last year, 134 randomised control trials into homeopathy had been undertaken: 59 produced positive results; eight produced negative results; and 67 produced results that were not statistically significant. In addition, four out of five large meta-analyses have reached broadly positive conclusions.
As well as that quantitative research, qualitative, real-life studies into homeopathy have shown clear improvements in patients’ perceptions of their illnesses and well-being. For instance, on page 26 of our document, an outcome analysis of 6,544 outpatient consultations at the Bristol Homeopathic Hospital is described, and it concluded that more than 70% of clinical patients had reported a clinical improvement. Furthermore, there is increasing evidence for the benefits of homeopathy in what are known as “effectiveness gaps”, which are areas in which no effective, conventional treatments are available.
Therefore, although critics of homeopathy seek to propagate the myth that there is no evidence for its effectiveness, a significant body of evidence demonstrates that it is effective.
I shall draw my remarks to a close by speaking about our proposals for Northern Ireland, the details of which are explained from page 10 onwards in our document, which was produced as a consequence of a request from the Department of Health, Social Services and Public Safety to submit a business plan.
In the document, we outline two potential service-delivery models for Northern Ireland. Option A proposes a centre of excellence that would mirror the existing models in Bristol, Glasgow, Liverpool, London and Tunbridge Wells. Under that option, GPs would refer patients to a recognised centre, where referrals would be triaged and assigned to a designated doctor. All consultations would take place in the centre, and the model includes the option to establish other satellite clinics throughout Northern Ireland. We envisage such a centre’s being used as a base from which to develop and promote homeopathy to healthcare professionals — including those working in medicine, pharmacy and nursing — and to the general public. In addition, an education programme would be arranged — one has already been outlined — and based in the centre in order to further develop the service. Furthermore, a tertiary referral link would be established with one of the NHS homeopathic hospitals in Great Britain, such as Glasgow or London, whereby difficult cases could be discussed with world leaders in homeopathy and referred on to that tertiary level.
Option B overlaps option A, and it involves homeopathic clinics being geographically spread throughout Northern Ireland by establishing them in existing health centres, new health-and-care centres and GP practices. Such clinics would be staffed by homeopathic doctors, who would accept referrals from the immediate vicinity or from within practice boundaries. Faculty of Homeopathy members have had fruitful discussions with several potential venues in which, given adequate funding, such clinics could be developed, ensuring wide coverage throughout each of the six counties.
In addition to homeopathy, several doctors who are trained in other complementary therapies are working in the Northern Ireland Health Service. Therefore, we urge the Department to develop strategies to utilise the talents that already exist in the NHS, including those offered by people who practise homeopathy and the many GPs who practise acupuncture. Whichever model the Department decides to implement, the faculty intends to maintain a close working relationship with it.
The Faculty of Homeopathy has members throughout Great Britain and Ireland, so a cross-border, North/South link is a distinct possibility, and we have held initial discussions about that with faculty members in Dublin. As well as the North/South link, there would be east-west co-operation with London and Glasgow.
I shall leave with you a summary of the matters that I sought to highlight: better health through homeopathy; the potential to generate savings in the prescribing budget; utilising existing talents in the Health Service; patient safety through statutory regulation and protecting patients from unregulated practitioners; and patient demand for equality with the rest of the UK, so that in the NHS’s sixtieth year, we might at last see a homeopathy service established in Northern Ireland.
In conclusion, I urge the Committee to consider those matters and to recommend that such a service be established in Northern Ireland under the guidance of the Faculty of Homeopathy.
I apologise for running slightly over my allotted 10 minutes, and I am happy to take any questions. I have spoken at length, so I am keen for other members of our delegation to answer some questions.
The Deputy Chairperson:
Thank you very much for your highly informative presentation, Gary. Today — even at the lunchtime meeting — I have learnt a great deal about homeopathy that I did not know before.
Your submission states that homeopathy has the potential to reduce the prescribing budget significantly. Is there any hard evidence of that from England or Scotland, for example?
Dr Peter Fisher (London Homeopathic Hospital):
The answer to that is yes, there is hard evidence, particularly from France and Germany, where the use of homeopathy is significantly higher than in the UK. The annual usage rates are: between 12% and 15% in the UK; almost 50% in France; and between 30% and 40% in Germany, the Netherlands and Belgium. The system works slightly differently in those countries than in the UK.
However, the insurance companies, particularly in Germany, have taken a keen interest. They know that homeopathy is popular, and that adding homeopathy to their insurance packages will attract more patients, which, therefore, makes sound commercial sense. The companies wanted to know whether they would have to charge more for insurance packages that incorporated homeopathy.
The concept of integration is crucial, whereby homeopathy is provided by qualified doctors in a normal healthcare setting, rather than as a stand-alone service. Several major insurance companies, or Krankenkassen, in Germany compared the cost of attending a doctor who provides an integrated homeopathy service with a doctor who does not provide that service. There is clear evidence from France and Germany that the integration of homeopathy provides more bang for your buck. Several studies, mostly sponsored by fairly hard-nosed insurance companies, demonstrate that the integration of homeopathy does not cost any more but produces better outcomes.
The Deputy Chairperson:
Gary, you said that members of your faculty are the only practitioners of homeopathy here that are regulated. Does that mean that others who are practising are unregulated?
Dr Smyth:
That is correct.
The Deputy Chairperson:
Is there a high level of that here?
Dr Smyth:
I do not know the exact figures, only that there are quite a few.
Dr Fisher:
From a European perspective, there are, in truth, probably more unregulated, or perhaps unregistered, practitioners than regulated practitioners. However, by definition, the fact that they are not registered means that we do not know how many exist, but it is clear that more are unregulated. In not regulating, the UK is fairly isolated in Europe, although several other countries do not regulate fully. I cannot comment on the situation in Northern Ireland, but across the UK there are probably more unregulated than regulated practitioners.
The Deputy Chairperson:
Surely regulation protects everyone — patients and doctors.
Dr Fisher:
Absolutely.
Dr Smyth:
We consider regulation to be a key issue, and one that perhaps led us to be here today. Some practitioners, although they have an enormous understanding of their subject, are, nevertheless unregulated. Therefore, as you correctly said, patients are potentially at risk.
Mrs Audrey Kerr (Faculty of Homeopathy Northern Ireland Branch):
We know that the Department is extremely interested in mental health and in prevention and education. I have direct contact with most of the patients who undergo homeopathic treatment. The two most frequently asked questions are whether the practitioners are medically qualified and whether any of them specialises in mental health, and it is rare for a patient not to ask one of those questions. We have discussed some of the myths about homeopathy today, and I have spent time educating patients and trying to dispel those. Having talked to me, many of them realise fully what is meant by “holistic”.
In 1985, everyone was talking about holism, because doctors were looking at parts of a patient’s body rather than at how the illness was affecting everything about a patient. The one thing that the patient likes — even loves — is the personal encounter with an individual who is willing to see him or her as a whole person and to provide the proper treatment, homeopathically. The treatment is safe, and the patient becomes secure in it. Quickly, they begin to want to learn.
People whom I know now say that it is imperative that we have a better system for our children and grandchildren than the system that we have now. This is our opportunity to provide that system.
Twenty years ago, we were excited to meet the Health Committee, but, over time, that excitement turned merely to soldiering on. However, the opportunity has arisen to see young blood willing to take it on; that is wonderful. I was looking forward to meeting the Health Committee, because I knew that it contained many female members, and homeopathy does a great deal for women’s ailments. It is nice to see men taking the interest that women showed previously.
Pressures on women today — looking after the home, working and doing all the things that they should or should not do — mean that pressure is put also on the homes. As a result, there is a great deal of sickness and psychological issues. Homeopathy has a wonderful way of dealing with those problems — without going down the road of using tranquilisers. It is a big plus to know that someone is interested in the patient as a person and realises that the patient’s whole body is asking for help.
Dr Sara Eames (Royal London Homeopathic Hospital):
I am the president of the Faculty of Homeopathy Northern Ireland Branch, and I work also at the Royal London Homeopathic Hospital. There is evidence of cost-effectiveness in real-life situations. Reports and studies from GPs’ surgeries show that GPs who use homeopathic medicines come from low-prescribing practices. That will be of interest to anyone who runs a health service.
Large hospital outcome studies have been carried out. Dr Smyth mentioned the study from Bristol, which consisted of a prospective study of more than 6,000 people. Together with the outcome studies from the other hospitals, the Bristol study showed, consistently, that its patients — most of whom are chronically ill — reduce their conventional medicine as a result of attending the hospitals. The reason for that is not that we tell patients to reduce their intake of conventional medicine, because we know that that would be dangerous. The reduction in their conventional medicine happens organically — their conditions improve, and they feel that they do not need the conventional medicine any more.
In the long term, the integration of homeopathy into the Health Service has positive cost implications.
The Deputy Chairperson:
Is it OK for a patient to take conventional medication and homeopathic treatments together?
Dr Eames:
Yes. That is one of the advantages of having statutorily registered health professionals — they can advise on both types of medication, and they can instruct the patient on how to balance both types safely.
Dr Fisher:
Many of the patients who come to us want to reduce their conventional medications. In many cases, that can be done, but it must be handled with care and with the knowledge of the possible consequences of reducing the conventional medications. Patients want to reduce their intake of conventional medication because they may be suffering side effects. We have data to show that we can help many of them.
Mr Easton:
Thank you for your interesting presentation. I suffer from hay fever; have you any suggestions as to what will help me?
Dr Fisher:
We wrote a review for the World Health Organization. We looked at all the clinical trials, and the strongest evidence in favour of homeopathy is its effect on seasonal allergic rhinitis, which is otherwise known as hay fever. Homeopathic treatments work on hay fever.
Mr Easton:
I will talk to you later.
You have met with the Minister’s officials and made a proposal. Have you had any response on that? How much would the establishment of a homeopathic service in Northern Ireland cost?
Mrs A Kerr:
We have not yet had our meeting with the Minister. That will take place at the end of January 2009. During the pilot scheme, Christine Jendoubi and the two gentlemen who were working with her invited us to talk about what had gone on in the Province, and how doctors were rolling out a service, albeit in the private sector. It is fair to say, and they can answer that for themselves, that the departmental officials were fascinated at the story of how much was being done for patients in Northern Ireland.
As a result of that meeting, we were given the opportunity to appear before the Committee. In the meantime, we lobbied the politicians in our own areas so that they got to know us. We spoke to them about homeopathy and assessed how much they knew about it so that we could move things forward. We hope that when we meet the Minister, he will be positive, because positive vibes are reaching us across the board. People are saying that there is something in homeopathic medicine, and that perhaps we should do something about it. Now is the right time.
Mr Easton:
How much will your proposals cost?
Dr Smyth:
Our business plan contains some financial considerations. The cost of setting up the service will largely depend on whether a centralised model is chosen that required the purchase of premises, or whether a decentralised model is preferred, in which homeopathic doctors are fitted into existing health and care centres, and premises would not have to be purchased. We propose a salary that is similar to that of a GP with a special interest, a grade-E pharmacist or a band-seven nurse practitioner, depending on who provided the service. The salary for the service would be comparable to that of a GP with a special interest.
Mr Gardiner:
I thank Dr Smyth for his presentation. It is sad to have to read in his submission that, on 4 March 1985, the Health and Social Services Committee presented its report on the subject of a homeopathy service to the Assembly and recommended to Douglas Hurd, the then Secretary of State for Northern Ireland, that its recommendations be implemented in full. After having had an opportunity to listen to you over lunch, you have enlightened me more. However, there is a great deal of ignorance of the subject in Northern Ireland, and we do not know an awful lot about what it is that you are talking about, and how it affects us.
I understand that you will be meeting the Minister in the next few months. I know the Minister personally; he is a brilliant Minister and is perhaps one of the best Ministers that the Health Service has ever had. If the Executive make the funding available, I imagine that the service will get up and running. The Committee will urge him to take that on board, and I will write to him and encourage him to do that.
Mrs A Kerr:
In the meantime, in my position as faculty liaison officer, I have been ringing around health centres at my own cost in order to find out how much they know and the size of the gap in their knowledge. I believe that an invitation is there. I understand that every health centre closes down for half a day a month for a business meeting, and their representatives have said that they would be happy to have us in to educate them. Without education, we will be lost. There is a preparatory job to be done, and it is amazing how many people are asking us to come to their mothers and toddlers’ groups or to their church groups. Wherever there are people facing illness, there are people like Alex Easton who are looking for relief from seasonal ailments such as hay fever. I am sure that he could get a consultation, and we could do a trial on him.
Mr Gardiner:
That is encouraging. [Laughter.]
Mr Buchanan:
Thank you for your presentation. First, what training will GPs need before they can prescribe homeopathic medicine? Secondly, what sort of training will be offered, and what is the time frame for that? Have you given any thought to the cost of training GPs? Your business plan states that it is anticipated that patient demand for the service will be high. What research has been done to show that patient uptake will be significant enough to justify the use of homeopathic medicine in Northern Ireland? Obviously, if such a service were set up, there would need to be a demand for it, and there would need to be figures that demonstrated that need.
Alex asked about how much it will cost the Department to set up a homeopathy service in Northern Ireland. I heard no clear answer to that question. Therefore, I ask again: how much will it cost the Department to set up that service? In the business plan, you write about establishing a service within the next six to 12 months. How much will it cost the Department?
Dr Eames:
I will speak about the issue of education, because that is very much linked to the Faculty of Homeopathy’s training programme. The Faculty of Homeopathy plays an educational and accrediting role. There are two main levels of homeopathic training. The first level is a basic course that all statutorily registered health professionals can do. That is an introductory course that is taught at centres over five or six days, at the end of which the health professionals sit a very basic exam. The exam qualifies them to have an intelligent discussion with their patients about homeopathy and to prescribe about 30 remedies in an acute first-aid situation. The conditions that can be treated are similar to those that pharmacists might treat using over-the-counter remedies or with some medical advice.
The second level of training is a more intensive programme that requires two further years of part-time study, which healthcare professionals undertake while working. On completion of the course, they gain a qualification from the Faculty of Homeopathy. Once a doctor reaches that level, he or she is able to work independently as a homeopathic specialist. The programme provides doctors with the ability to manage more complicated diseases, as well as patients with chronic disease and multiple pathologies.
If one is trying to establish a homeopathy service in an area, it is useful if many GPs there have done the initial, basic training. The basic training provides them with the knowledge to support patients who are seeing specialists and to use acute remedies, which can reduce their own prescribing costs. Once patients hear more about homeopathy services, and try one or two acute remedies that they find helpful for them and their families, their interest in, and demand for, other consultation services increases. Some people call that the halo effect, because they think that the need for a service is simply built up. However, people very often choose homeopathy services instead of other services that were already funded.
Therefore, GPs can be trained in offering homeopathy services at an introductory level very quickly. At present, in the rest of the UK, health professionals, if they decide to do the training, normally fund it themselves. The Committee may want to come up with a different plan, if a decision is taken to train many people rather quickly.
Mr Buchanan:
First, I asked another question about how much it will cost the Department to set up such a service. I may have missed your answer. Secondly, what percentage of GPs will need to buy in to this in order to make it an effective and worthwhile service in Northern Ireland?
Mrs A Kerr:
I can answer that question, because I have also done a bit of work in that area. The issue is not about whether an extra service should be provided; rather, it is about integrating a homeopathy service into the existing Health Service. However, it will take time to implement that.
Politicians talk about giving patients more choice of treatments. We want to be able to get GPs who are unfamiliar with homeopathic medicine, but who are concerned about their patients, to allow a homeopathic practitioner into their premises, where secretarial staff, for example, are already established. It takes little to train those staff to be able to deal with patients who want homeopathic treatment. If two doctors, or the doctor and the nurse practitioner, work together, a good, cost-effective service can be rolled out, even if there is not much time in which to do that.
I cannot give you financial figures, but I can tell you that people who have been helped through homeopathic medicine do not need to visit their doctors nearly as often. Initially, they try to treat themselves on a first-aid level. If one believes in the principle of stimulating one’s immune system, one can learn to help oneself.
People are currently tapped into health issues, particularly mental-health issues. They seek answers and choices. If politicians allow them to be given those choices, our professional groups can work together in order to provide them for the good of patients. You will not be disappointed.
Sam can ask the Minister to give us three years for starters. If we find that it is going well and that we need a little more time, we can perhaps have an extra few years. At present, I cannot give the Committee a figure in pounds, shillings and pence.
Dr Smyth:
I want to return to Mr Buchanan’s points. As regards patient demand, the Department commissioned a Social and Market Research report in 2006, entitled ‘Public Attitudes to Health and Social Services in Northern Ireland’, which suggested that, during the previous 12 months, 23% of respondents had used complementary medicine, with 60% of patients showing a high degree of support for GPs referring to complementary therapists. There is, therefore, a high degree of support for that practice. The majority — 55% — of the public was in favour of such a service being available on the Health Service.
That relates to general complementary medicine. I am not aware of the breakdown of that that relates to homeopathy. Certainly, it shows that there is a high degree of interest and patient demand for complementary medicine to be available in the Health Service.
You also mentioned costs, Thomas. I understand that you do not believe that you have received an appropriate answer on costs thus far. We have not carried out a detailed financial analysis of the full cost to the Department for several reasons, one of which is that we have, as yet, been unable to become as involved with the Department as we would like.
An independent report has been carried out on the one-year pilot project. We have sought access to that report but have been unable to obtain it. We understand that that report shows that a fair degree of interest exists in favour of homeopathy, not just in complementary medicine. I understand that it also goes into detail on costs.
Page 15 onwards of our business plan provides a brief outline of our estimated costs. However, as I said, we have not carried out a detailed financial analysis. We look forward to doing that before any service is rolled out.
Mr Gallagher:
Homeopathy has a role to play. People with certain conditions might respond better to homeopathic remedies than to traditional medicines or treatments. We should get into step with other parts of the UK.
I am not sure about the position in the Republic of Ireland. Perhaps some of the witnesses can inform the Committee on that. The co-operation that Gary mentioned is very important, not to mention very natural on this island.
Page 26 of your business plan details some very impressive figures for clinical outcome studies. The most impressive ones that I can see are those relating to the clinical improvements in asthma and eczema among under-16s. Those conditions are very distressing for children and their families. Although those figures are impressive, a cynic may say that those figures cover children who may have grown out of those conditions. What are your views on that?
Dr Smyth:
The faculty has a number of members in the Republic of Ireland; in Dublin, Cork and various other places. There is no NHS in the Republic of Ireland, so those practitioners work privately. Some of them have expressed an interest in helping us to provide a service here in the North, particularly in the border regions. Therefore, they are very interested in working with us and in helping to create some form of cross-border link.
Will you remind me of your question on the outcome studies?
Mr Gallagher:
My question related to the fact that the most favourable results were found in those under 16 years of age. Perhaps it was the two conditions — asthma and eczema — that demonstrated the best results?
Dr Fisher:
I have been involved a little in the area of cross-border links. My experience was not in the provision of homeopathy but on the regulations surrounding homeopathy. There are European directives on homeopathic medicines, but issues also arise on local implementation and interpretation of those directives. I have been involved in some discussions between practitioners in London and Dublin, and Dublin, more or less, follows the London lead on how the European regulations are interpreted locally. Therefore, at that level, there is some co-operation, and the interpretation of those regulations is very similar.
There are, of course, weaknesses in clinical outcome studies. For example, one follows up only on some patients, while others drop out. Indeed, one of the criticisms that has been levelled is that patients only seem to improve, because those who do not improve drop out and only those who are doing well continue to attend. In fact, that does not appear to be the case. A recent analysis examined the last value of those patients who dropped out against those who continued to attend. The results of that study suggest that patients stopped attending because they do not need to attend any more. On average, they were doing better when they dropped out than those who, at the same point, continued to attend.
Control studies are required, in order to ensure that homeopathy is a real thing. As I have mentioned, control studies were conducted into hay fever, which is closely related to asthma. The results for homeopathic treatment of those two conditions, plus results for treatment of eczema, produced better results than for the use of placebos alone, and they were comparable to conventional treatments.
There are ups and downs; for example, conventional treatment means putting steroids on children’s skin, which many people — for good reason — do not like to do. The comparison with placebo-controlled studies returned better results. As I said, the results were also broadly comparable to that for conventional treatment — but safer.
The Deputy Chairperson:
OK. No other member has indicated a desire to speak. I thank all the witnesses for attending today. You have provided the Committee with a great deal of information. The Committee will consider that information and see what else we can do. Thank you very much.