Guidance on Prescription of Homeopathic Treatments: Ramifications of a Failed Administrative Law Challenge.

In R (on the application of British Homeopathic Association) v National Health Service Commissioning Board [2018] EWHC 1359 (Admin) Supperstone J of the High Court of England and Wales delivered an internationally significant judgment on the processes required to be engaged in when guidance is given to medical practitioners about their involvement in homeopathic prescribing. This column explores the bases upon which the challenge by the British Homeopathic Association was lost and the repercussions of the judgment for the practice of non-evidence-based modalities, such as homeopathy.

Running an NHS community homeopathy clinic - 10-year anniversary 2001-2011.

An outcome series was conducted over a five-year period of patients attending a community NHS homeopathy clinic in Dorchester, Dorset. 273 new patients were seen. 183 (67%) questionnaires were completed at six months after initial consultation. 44% of patients had been unwell for more than five years; 19% of all patients for more than 15 years. A wide variety of conditions were seen, the largest group with depression, anxiety or grief. For follow-up patients 75-81% indicated an improvement in their symptoms and activity while 58% recorded an improvement in their overall wellbeing. Six months after the initiation of treatment 155 (84.7%) felt an improvement in their condition with 148 (81%) attributing this to homeopathy. Nobody reported deterioration due to homeopathic treatment; conventional drug use was reduced in 46 patients (25%).

To feel what others feel: two episodes from 18th century medicine.

In the late 18th century two medical fashions--Mesmerism in France and the Perkins 'tractor' in the USA and England--appealed to the principle that a single universal force acts on all of us and is responsible for health and illness. This principle served both fashions well, as it made it all the easier for those who came within their force fields to experience the sort of sensations that other subscribers to the fashion also seemed to feel. The first research on what is now known as the placebo effect was in connection with these two movements. The propensity to feel what we suppose or imagine that others like us feel remains even now one of the channels of the placebo effect.

Margaret Cavendish's materialist critique of van Helmontian chymistry.

A striking omission in the scholarship on the reception of the chymical philosophy of Jan Baptista van Helmont in England in the seventeenth century is the work of the mid-seventeenth-century natural philosopher Margaret Cavendish, Duchess of Newcastle. In her Philosophical Letters (1664), Cavendish offers an extended critique of Van Helmont's work (whose Ortus Medicince had recently been translated into English by John Sadler). In this paper, I compare Cavendish's criticisms with those of Robert Boyle in his Sceptical Chymist (1661). Both Boyle and Cavendish attacked Van Helmont for the obscurity of his chymical vocabulary and concepts, and attacked his seminalism. Although their critiques had much in common, they diverged in their attitudes to Van Helmont's experiments. As an opponent of the experimental philosophy, Cavendish had little interest in the quality of Van Helmont's experimental claims, whereas Boyle was critical of their unreplicability. I also try to show that the two writers had very different polemical agendas, with Boyle defending his vision of chymistry based on a corpuscularian natural philosophy, and Cavendish being as much concerned with establishing her religious orthodoxy as with defending the truth claims of her own materialist vitalism. For Cavendish, Van Helmont was an example of the dangers of mingling theology and natural philosophy.

Thomas de Quincey and his restless legs symptoms as depicted in "Confessions of an English Opium-Eater".

Thomas de Quincey, a British writer of 19th century, suffered insomnia from the age of 17 years. In his famous "Confessions of an English-Opium Eater" (1822), he described a symptomatology that could concord with restless legs syndrome long before he became addicted to opium. In this report, we analyze his clinical description and the circumstances leading to his opium addiction.

Treatment appraisals and beliefs predict adherence to complementary therapies: a prospective study using a dynamic extended self-regulation model.

OBJECTIVES: Complementary and alternative medicine (CAM) is used by large numbers of the general public and is increasingly becoming integrated into the mainstream. An understanding of why people use CAM in general has been developed in the literature, but relatively little is known specifically about adherence to CAM. We tested hypotheses (derived from a dynamic extended version of Leventhal's common-sense model) that patients' beliefs about treatment, perceptions of illness, and treatment appraisals would predict adherence to CAM. DESIGN: A prospective self-report questionnaire study was carried out with a 3-month follow-up period. METHODS: A total of 240 patients from five CAM clinics completed self-report questionnaire measures of treatment beliefs, illness perceptions, and treatment appraisals at baseline. Three months later, they completed self-report measures of adherence to therapists' recommendations concerning attendance, remedy use, and life-style changes. RESULTS: Logistic regression analyses showed that positive perceptions of one's therapist and belief that mental factors do not cause illness independently predicted adherence to appointments. Positive beliefs in holistic health and finding it difficult to travel to appointments predicted adherence to remedy use. Using homeopathy was the only independent predictor of adherence to life-style changes. CONCLUSIONS: Treatment appraisals, treatment beliefs, and illness perceptions explain modest proportions of the variance in adherence to CAM. This study highlights the value of operationalizing the appraisal element of the common-sense model when investigating adherence to treatment.

Is use of homeopathy associated with poor prescribing in English primary care? A cross-sectional study.

Objectives Prescribing of homeopathy still occurs in a small minority of English general practices. We hypothesised that practices that prescribe any homeopathic preparations might differ in their prescribing of other drugs. Design Cross-sectional analysis. Setting English primary care. Participants English general practices. Main outcome measures We identified practices that made any homeopathy prescriptions over six months of data. We measured associations with four prescribing and two practice quality indicators using multivariable logistic regression. Results Only 8.5% of practices (644) prescribed homeopathy between December 2016 and May 2017. Practices in the worst-scoring quartile for a composite measure of prescribing quality (>51.4 mean percentile) were 2.1 times more likely to prescribe homeopathy than those in the best category (<40.3) (95% confidence interval: 1.6-2.8). Aggregate savings from the subset of these measures where a cost saving could be calculated were also strongly associated (highest vs. lowest quartile multivariable odds ratio: 2.9, confidence interval: 2.1-4.1). Of practices spending the most on medicines identified as 'low value' by NHS England, 12.8% prescribed homeopathy, compared to 3.9% for lowest spenders (multivariable odds ratio: 2.6, confidence interval: 1.9-3.6). Of practices in the worst category for aggregated price-per-unit cost savings, 12.7% prescribed homeopathy, compared to 3.5% in the best category (multivariable odds ratio: 2.7, confidence interval: 1.9-3.9). Practice quality outcomes framework scores and patient recommendation rates were not associated with prescribing homeopathy (odds ratio range: 0.9-1.2). Conclusions Even infrequent homeopathy prescribing is strongly associated with poor performance on a range of prescribing quality measures, but not with overall patient recommendation or quality outcomes framework score. The association is unlikely to be a direct causal relationship, but may reflect underlying practice features, such as the extent of respect for evidence-based practice, or poorer stewardship of the prescribing budget.

Depressed patients treated by homeopaths: a randomised controlled trial using the "cohort multiple randomised controlled trial" (cmRCT) design.

BACKGROUND: Despite controversy regarding homeopathy, some patients consult homeopaths for depression. Evidence is required to determine whether this is an effective, acceptable and safe intervention for these patients. METHODS: A pragmatic trial using the "cohort multiple randomised controlled trial" design was used to test the effectiveness of adjunctive treatment by homeopaths compared to usual care alone, over a period of 12 months in patients with self-reported depression. One third of patients were randomly selected for an offer of treatment provided by a homeopath. The primary outcome measure was the Patient Health Questionnaire (PHQ-9) at 6 months. Secondary outcomes included depression scores at 12 months; and the Generalised Anxiety Disorder (GAD-7) outcome at 6 and 12 months. RESULTS: The trial over-recruited by 17% with a total of 566 patients. Forty percent took up the offer and received treatment. An intention-to-treat analysis of the offer group at 6 months reported a 1.4-point lower mean depression score than the no offer group (95% CI 0.2, 2.5, p = 0.019), with a small standardized treatment effect size (d = 0.30). Using instrumental variables analysis, a moderate treatment effect size in favour of those treated was found (d = 0.57) with a between group difference of 2.6 points (95% CI 0.5, 4.7, p = 0.018). Results were maintained at 12 months. Secondary analyses showed similar results. Similar results were found for anxiety (GAD-7). No evidence suggested any important risk involved with the intervention. CONCLUSION: This trial provides preliminary support for both the acceptability and the effectiveness of treatment by a homeopath for patients with self-reported depression. Our results provide support for further pragmatic research to provide more precise estimates of treatment effect. TRIAL REGISTRATION: ISRCTN registry, ISRCTN02484593 . Registered on 7 January 2013.