Letter asking insurers 'why would you cover homeopathy?'

Several fans of homeopathy have recently posted, on Twitter, a page from the Society of Homeopaths listing the insurers that will cover homeopathic treatment. That insurers would cover homeopathy at all really surprised me.

If I'm paying out a small amount of money I might take a bit of a gamble on something, but if large sums of money (or lots of small amounts of money) were involved I'd be a bit cannier about it. I'd naively assumed that insurers wouldn't pay out any money unless they absolutely had to, and that they'd also be very aware of the lack of good evidence for homeopathy - presumably it's in their financial best interests.

I'm quite prepared to entertain the idea that they just 'let it go' as a loss leader - ie they know they will make money elsewhere so don't mind losing on it in that context, or find that advertising that they offer homeopathy cover turns out to be good PR. I also speculated, and I'm certain others have considered this, that the 'worried well' users of homeopathy could be taking more of an active interest in their health and may be likelier to spot any genuine problems sooner and hence 'be cheaper'... or possibly this just highlights how little I know about the ways in which insurance companies operate ;)

Having read some general comments, on Twitter, about people's views on homeopathy, it also occurred to me that it was not impossible that the insurers had confused homeopathy with herbal remedies, or that they didn't know about the lack of evidence.

I decided to email a few and ask - admittedly my first email (below) probably isn't going to get me the most clear cut answers as it asks fairly general questions so I think I'll tweak it a bit before sending it to the rest. I'm not going to post individual responses from insurers (I always really enjoy reading everyone else's exchanges but always feel a bit guilty - I'm just not that comfortable about sharing others' emails in that way) but I've heard back from only a handful so far: some are 'looking in to it', some just thank me for my comments, some send automated 'your email has been received' so I'm not sure if there's more to follow from them, and of course some haven't responded and perhaps never will.

There'll be some pruning of this in the next week or so, and I'll send it to the rest. What I really want to know is 'what evidence convinced you that this was worth spending money on?'.
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I am looking at the webpage of the Society of Homeopaths (http://www.homeopathy-soh.org/about-homeopathy/funding-your-treatment.aspx) and see that your organisation is one of a number of health insurers who cover homeopathic treatments, and I was wondering... why? It would seem (to me) that companies which are covering homeopathy are at risk of paying out money that they don't need to.

Lately homeopathy has come under a great deal of scrutiny - most recently at the House of Commons' Science & Technology Committee evidence check. The House of Commons S&T Comm ran a series of evidence checks (in which they considered whether there is evidence to support Government policy on a variety of topics) and homeopathy was one of them. The uncorrected transcripts of the meetings are available in links given at the end of this email.

In the first evidence check session Paul Bennett, Boots' Professional Standards Director, acknowledged that Boots has no evidence that homeopathy is effective (beyond placebo) but that Boots makes the products available for the benefit of patient choice (see questions 4-6 in link 1 below).

The rest of the discussions are pretty clear that placebo effects (which are a part of any therapeutic intervention of course) can explain any positive results of homeopathy, and that homeopathic products do not have any effect beyond placebo. Additionally, as the process of preparing a homeopathic remedy involves successive dilutions to the point at which it's unlikely there's even a molecule of active ingredient present then homeopathic products would seem to be no more than 'dummy pills', sold at great profit (http://timesonline.typepad.com/science/2010/01/homeopathy-by-the-mindboggling-numbers.html).

I wondered if people who use homeopathic treatments are perhaps monitoring their health more closely in general. If so I can see that it might be financially worthwhile providing homeopathic cover, as a kind of 'loss leader', for these motivated patients who are using otherwise ineffective treatments, or if homeopathy falls within a general 'complementary medicine' category, which also includes herbal remedies (these do contain active ingredients)?

You may have heard of the 1023 campaign (http://http//www.1023.org.uk also see articles in the Times and Telegraph, see links 3 and 4 below) which is aiming to highlight that there's nothing 'in' homeopathy, and to ask Boots to stop selling as medicines products for which there is no good evidence. The focus is on Boots because of their 'no evidence' admission at the evidence check.

During this campaign the issue of homeopathy has been much discussed on Twitter (using the hashtag #ten23) and a number of homeopaths and supporters of homeopathy have highlighted that the treatments are covered by health insurers.

Although I was aware that the NHS spends money on homeopathy (though a little less since the Tunbridge Wells homeopathic hospital closed http://news.bbc.co.uk/1/hi/england/kent/7015675.stm) I had not realised that homeopathy would be covered by private companies and would like to ask why your organisation covers homeopathy and what evidence was used in deciding that it should be covered.

Many thanks,
Jo, supporter of (but not affiliated with) the 1023 campaign.
London.

1. Wednesday 25 November 2009
First session (evidence from Paul Bennett, Ms Tracey Brown, Dr Ben Goldacre, Prof Jayne Lawrence and Mr Robert Wilson) and second session (evidence from Prof Edzard Ernst, Dr Peter Fisher, Dr Robert Mathie, and Dr James Thallon). http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/uc45-i/uc4502.htm

2. Monday 30 November 2009
Single session
(evidence from Mr Mike O'Brien, Prof Kent Woods and Prof David Harper).
http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/uc45-ii/uc4502.htm

3. Times Online: No cure for the credulous
http://business.timesonline.co.uk/tol/business/columnists/article6994273.ece

4. Telegraph.co.uk "Boots hit by mass homeopathy 'overdose'
http://www.telegraph.co.uk/health/healthnews/7028989/Boots-hit-by-mass-homeopathy-overdose.html