Fortunately NHS England isn't wasting that much money on homeopathy prescriptions now - though still not zero (it's over £20k)

tl;dr - in the last financial year NHS England spent £21,170.37 on 866 homeopathic items. In the last calendar year (2020) it was £28,597.58 on 1,004 items.

For the latest figures there are two files as NHS BSA has made a change to their system - there's now a calendar year version and a financial year version. 

NHS Homeopathy Spend - England 2020-2021 - document 1 of 2 (summary Doc)
NHS Homeopathy Spend - England 2020-2021 - document 2 of 2 (summary Sheet)

The Salisbury Homeopathy College appears to have shut its doors

Salisbury #Homeopathy College is apparently permanently closed (hooray) & no longer accepting applicants. Its website still implies that it's courses are accredited by the Society of Homeopaths but the Soc has already removed it from its own list of accredited course providers. pic.twitter.com/sVtbgMSixb

— Jo-nuary Blues 🌊 ❄️ (@JoBrodie) February 7, 2021

It's always cheering news when something comes to an end in the world of homeopathy. We've seen University courses close, websites taken down or amended, and of course the numbers of homeopathic items prescribed on the NHS have been dropping precipitously for a couple of decades (it's still clinging on though). 

Recently things have taken an even worse turn for homeopathy with bad news for homeopaths appearing in newspapers every few months, following a series of undercover reporting finding homeopaths making misleading claims and offering fake treatments or preventatives.

In January this year the Society of Homeopaths (SoH) lost its accreditation from the Professional Standards Authority (PSA). The PSA was concerned that the SoH had failed to prioritise public safety over the interests of its members and suspended accreditation, to be reviewed in one year. 

The Salisbury Homeopathy College was one of several colleges to have a course accredited by the SoH, which keeps a list of accredited courses on its website. This listing appears to have been removed some time after October 2020, though the College's own website still carries SoH logos and the suggestion that its courses are accredited. 

However it appears that the Salisbury Homeopathy College has now permanently closed. Its website says that it's no longer accepting applicants and its listing on Google indicates closure beyond mere opening hours. I don't know why it's closed or when that happened, but sadly the SoH still lists plenty of other places which will charge people fairly large sums of money (several thousand) to teach them nonsense. 

You can read about one skeptic blogger's visit to the College on its open day in 2018. One of its courses cost nearly £10,000 - I'm amazed its former students don't sue.

Another big plummet in #homeopathy on the NHS England

NB - these figures relate to England only. 

There should be zero homeopathy items being dispensed on the NHS, costing zero pounds but because the prescription cost documents are published every April I assume they capture part of the preceding year.

The new prescription costs were published today and can be found here: Prescription Cost Analysis - England 2019. For previous editions see this page.

The relevant bit is in this spreadsheet
Prescription Cost Analysis 2019 – Statistical summary tables [Excel: 3.8MB] - I used Edit / Find&Replace as a way to quickly find all instances of homeop via a whole workbook search. I also checked for the variant spelling homoeop but didn't find anything.

The Chemical Substances (ho!) tab gives the overview / average and it's in Row 1764 - 2,188 items were dispensed (last year 3,295) costing £48,109.32 (last year £55,044) with the cost per item having risen by about £5 to £21.99 (compared with £16.71 last year).

The NHS dispensed a third fewer homeopathy items in 2019 than it did in 2018. Hopefully this asymptotic crawl to zero will speed up a bit in future.

Image above shows the number of homeopathic items dispensed and the cost, click to enlarge or use the text version below.

Table One

Dispensed items	Of which class 2 items	Total cost (£)	Cost per item (£)
2,188	0	48,109.32	21.99

More detail in the Presentations tab, Rows 11708 and 11709.

Table Two

Dispensed items	Of which class 2 items	Total quantity	Total cost (£)	Cost per item (£)	Cost per quantity (£)	Quantity per item
529	0	49,491	3,231.72	6.11	0.07	93.56
1,659	0	120,544	44,877.60	27.05	0.37	72.66

Homeopathy, pumice stones, magical thinking and flights of fancy

tl;dr - gibberish :)

"S13 felt burning in her chest around the heart chakra towards her throat, also in her sacral chakra and spleen meridian."

All of homeopathy is utterly silly but a particular sort of open-minded* dimwittedness descends on homeopaths when they decide to 'prove' a new 'remedy'. This involves asking a selection of people to try it out and report on every little event, feeling or other whim that occurs to them. Remarkably tenuous explanations for these experiences are offered, relating to some imagined properties of the source material. It's quite astounding.

There are also some very silly remedies indeed, many skeptics have enjoyed the homeopathic antics that have given us remedies made of Berlin wall (for separation anxiety I think, or some such guff) and owl (for sleeping problems probably). Absolute drivel.



Despite being unintentionally very funny it's also rather sad and reading the Proving of the Pumice Stone from Montserrat organised by Leeds Homeopaths throws up the strong impression that homeopaths seem very keen to ascribe external influences (eg the remedy under investigation) to quite ordinary daily annoyances. It is as if they don't believe they have much control over their own lives.

The document begins with the notion that initially set things off, that a pumice stone is vageuly similar to osteoporotic bone and perhaps it could form a remedy for osteoporosis. There's then a treatise on volcanic rock and on Montserrat, pointing out the island had suffered "a traumatic history of hurricane and volcano damage" and that the homeopaths "think there are parallels with this recurring damage and loss with the amount of work done during the proving analysis which was mislaid, lost, redone (and sometimes found again afterwards)". Oh dear.

A couple of the provers suffer accident or injury during the time of the proving - of course this is magically linked to some negative effect of the remedy. Amazingly these injuries are not immediately solved with homeopathy, as you might expect, but seem to cause more lasting problems. Not much of an advert for homeopathy!

"...another prover broke her arm on the way to take the prover's baseline appointmentand had to withdraw from the process as a consequence. (This same lady was then off work for 3 months and only recovered properly a year later)." - gosh, how is such a thing possible when we all know that taking a single pill nearly always solves such problems immediately!

Another homeopath "fell and tore her right Achilles tendon before the closing meeting which then meant she could not attend it as planned. It was a severe injury that took a long time to recover from and she still felt traumatised a year later." - this seems like a fairly straightforward injury for homeopaths to heal, surely.

As well as the injuries there are surprising examples of people getting stuck in traffic - things that hardly ever happen normally, apparently. OK this one is fairly rare but I expect there's a fairly mundane reason: "One prover had a wall socket catch fire for no apparent reason."

Quite a few of the dozen or so homeopaths involved dropped out or didn't complete their assignments but the next few pages of the 16 page PDF are full of a range of their reported irritations, illnesses or then suddenly feeling energised and capable (imagine if you were to write down every event or emotion that happened to you in a week, you might find a bit of variability!). There's even a bit about their dreams in there.

2020 seems like a really good time to put away childish things and give homeopathy up for good.

Their document was published in 2016 under a Creative Commons share alike licence, so I've used the same licence for this post in the unlikely event that you want to re-use it (even commercially). Be my guest (but you must link to this blog).

*as in so opens brains have fallen out


This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Misleading homeopathy marketing (again) - complaint submitted to Advertising Standards Authority

I'm grateful to 'BrownBagPantry' the prolific tweeter of homeopathy-related matters. Her screenshot of Alan's (zeno001) tweet alerted me to a problem with the claims made by Highgate Holistic Clinic in a tweet and on their website. I would have missed his tweet on the #homeopathy tag as Alan hadn't tagged it, so my thanks to BrownBagPantry for being solely responsible for bringing it to my attention and causing me to submit a complaint to the Advertising Standards Authority (ASA) about the clinic's misleading advertising. Had I been looking at the tag on Christmas Day I might well have seen the clinic's own tweet (as they did hashtag it) but I wasn't, so all credit to BrownBagPantry.

Normally if I'd spotted one of Alan's tweets about a misleading advert I'd have DMed him asking if he'd reported it and he might reply that he had, or that someone else had already done so, or that he was perhaps waiting until after the holidays before tackling it etc. However that's not going to happen today as I'm just going to get on with the complaint and add the text here here.

I've taken screenshots of the tweet and parts of the website to share with the ASA though I hadn't planned to add them here.

Background research
Highgate Holistic Clinic's website claims that the homeopath is a registered member of the Society of Homeopaths however double-checking on the 'Find a Homeopath' site indicates that she's a member of the Alliance of Registered Homeopaths, but doesn't mention SoH membership. As a courtesy I'll let the SoH know about this in case she isn't and the info is incorrect.

Text of my complaint to the ASA
Note - the online form doesn't permit hyperlinks (where the link is behind a word) so the link was pasted in full in a list at the end with a number in brackets next to the relevant part of my text, eg [1]. It also doesn't permit bold or italic so the text has been slightly reformatted for clarity here. The text of a complaint must also be less than 5,000 characters (I had about 1,800 to spare).

--oo--   --oo--   --oo--   --oo--   --oo--   --oo--   --oo--

I'm complaining about a tweet from a clinic, the text of which implies that homeopathy can cure conditions, and the content of two pages from the clinic's website.

The tweet
"#Homeopathy is based on the principle of ‘like cures like’. In other words, a substance taken in small amounts will cure the same symptoms it causes if taken in large amounts." - it is not possible for homeopathy to cure any symptoms so the text of this tweet is misleading.

The tweet links to a page on the clinic's website, which says
"Danielle Abramov is committed to homeopathy as it treats the person as a whole without the side effects of conventional medicine" - I think this statement may discourage people from visiting a doctor or from taking real medicine. It implies that medicine offers only side effects.

"...working with them towards improving their health naturally – offering a real alternative to or support for conventional treatment." - this implies that homeopathy is an alternative to conventional treatment, and also implies that it is a 'real' alternative. It isn't. I've no objection to 'support for conventional treatment' though.

"In India homeopathy is considered to be equal to allopathic medicine." - this is largely untrue but what is relevant here is the implication that homeopathy should be considered as some sort of real thing, implying that it can help people.

"Danielle Abramov is also a qualified Vega practitioner. The Vega machine is a non-invasive, painless, diagnostic tool for determining some of the causes of ill health, be it persistent viral, fungal or bacterial overload, vitamin or mineral deficiency, food intolerance or emotional blocks." - the Vega machine is not a valid diagnostic tool and you have previously noted that it is "not capable of diagnosing [respiratory allergy and sensitisation to common aero-allergens]", I do not believe it is capable of diagnosing viral, fungal or bacterial overload either. Also a lay homeopath [one who is not also a doctor or other healthcare professional] is unlikely to be competent to diagnose any health conditions (using this or any other 'diagnostic' tool).

The website also has a page on therapies that includes a section on homeopathy
The section on homeopathy says that it "... can help with many issues such as Asthma, Anxiety, Allergies, Bronchitis, Childhood Diseases

Coughs, Colds and Sore Throats, Depression, Digestive Disorders, Earache, Eczema, Exhaustion, Emotional issues, Fibroids, Grief, Headaches & Migraines, Menopause, Menstrual Complaints & Infertility, Pregnancy & Birth, Sleep Problems, Thyroid Imbalances, Urinary Disorders, Vaccination Side-Effects, Varicose Veins etc." - none of these can be helped by homeopathy, some are serious medical conditions that need appropriately qualified medical care and support. I also do not believe that homeopaths or clinics are allowed to list named conditions.

--oo--   --oo--   --oo--   --oo--   --oo--   --oo--   --oo--

What happens next?
Several years ago the ASA changed the way it handled homeopathy-related complaints. Rather than asking homeopaths to provide evidence for particular claims the ASA took a more holistic view and, recognising that homeopathy doesn't work for any condition, determined that any homeopathy claim was misleading and that there was no need to undertake an investigation for each complaint submitted. Instead, each complaint is handled as a case of non-compliance by the Compliance Team - so my complaint will be handled by them and I won't know the outcome (only adjudications are published).

There's apparently a complaint in with the Australian Commonwealth Ombudsman about the NHMRC's Homeopathy report

Update 4 Dec 2019: I've received a holding letter from the Ombudsman while they consider my request.

---

Well this'll be confusing :) The Australian National Health and Medical Research Council (NHMRC) released a report on homeopathy in 2015 pointing out that it's not much cop and shouldn't be recommended as a treatment. Lots of homeopaths were very cross about that and apparently three homeopathy-supporting societies* put in a complaint to the Commonwealth Ombudsman the following year, in August 2016, saying that the NHMRC had done wrong.

It's now November 2019 (three years and three months on) and to my knowledge the Commonwealth Ombudsman has not produced a verdict (or indeed a peep) about the apparent complaint.

In April 2017 Edzard Ernst reported on an article in What Doctors Don't Tell You which said that a complaint had been submitted. The Australian Skeptics society tried (in May 2017 and August 2017) to find out if there really had been a submission to the Commonwealth Ombudsman and were told by a source in August there that there was no record of submission.

A news article from ECHAMP on 22 January 2019 said that the Commonwealth Ombudsman's verdict was imminent. Still no sign of it though.

I've emailed the Commonwealth Ombudsman (copy below) to see if I can find out any other information. I'm not an Australian citizen so they might just ignore me, or they might be unable to tell me anything about an ongoing investigation. It's also possible that I've phrased things in the wrong way and I need to get better at FOIA requests!

*The Australian Homeopathy Association, Complementary Medicines Australia and the Australian Traditional Medicine Society. According to the Homeopathy Research Institute these three bodies used some of the HRI's own analysis of the NHMRC 2015 report. The HRI wrote about the complaint to the Commonwealth Ombudsman but the other three organisations appear to have been rather quiet about it.

---

Dear Commonwealth Ombudsmen and Ombudswomen :-)

I am writing to you under the FOIA scheme to find out about the existence and status of a complaint apparently made by homeopathy societies to you in 2016 about the conduct of and report from the NHMRC. Please note that I am not an Australian citizen (I'm British) so I'm not sure if you will be able to respond to me but if so please let me know if there's a charge, I will be happy to contribute. My questions are in red.

The reason that I am asking if any complaint has been made is because the existence of this submission from homeopathic societies has been called into question by the Australian Skeptics who could find no record of it (in April 2017). They also reported (in August 2017) that it appears that no submission was received by you, so its status is a bit of a mystery!

On the Homeopathy Research Institute's (HRI) page (below) they claim in the first paragraph that the Commonwealth Ombudsman is in receipt of a complaint submission from the CMA, AHA and ATMS August 2016. 1. Please can you confirm if you have received a complaint document from those organisations relating to the NHMRC?

The second paragraph implies that you made an initial assessment of their complaint and found that it was of sufficient merit to warrant an investigation. 2. Please could you confirm that you (a) made this assessment of its merit and (b) found that it warranted further investigation.

3. Could you also confirm if an investigation was launched and what meetings (dates) were set up and with whom (organisations).

Source / Linked PDF for Executive Summary

A news article from 22 January 2019, from European Coalition on Homeopathic & Anthroposophic Medicinal Products (ECHAMP) indicated that your verdict on this report was 'imminent'. 4. Are you preparing a verdict on any complaint you've received from these homeopathy societies?

Source

5. If so, will such a verdict be made public, and when?

Thank you very much

Jo Brodie

A burst of newspaper articles critical of homeopathy

tl;dr Thanks to efforts from the Good Thinking Society and skeptical activists homeopathy is in the news again, this time it's further criticism of the decision to accredit the Society of Homeopaths' register.

If you've enjoyed the recent burst of articles in the news that have been critical of homeopathy you might like to know that the Good Thinking Society are the people to thank for this. They are currently crowdfunding funds to support a Judicial Review against the decision to accredit the Society of Homeopaths. If you're able to, you can donate here.

---

The latest crop (and a bumper crop it has been!) of stories relates to the decision made by the Professional Standards Authority (PSA) to re-accredit the Society of Homeopaths (SoH) for 2019-2020 despite concerns that some of their members claim to treat autism and others offer 'alternatives' to vacination. Their re-accreditation is up again for renewal and anyone was able to share their thoughts about whether they should be re-accredited (I shared mine) as long as they submitted their thoughts by 22 October 2019. The SoH first received PSA accreditation in 2014.

• Going forward - quite a few people think the PSA should not re-accredit the SoH from Jan 2020 and have written to ask them not to do this
• Retrospectively - The Good Thinking Society (GTS) would additionally like a ruling on the PSA's previous re-accreditation of the SoH (2019-2020). They have been given permission to proceed with a Judicial Review to look into that decision, and to see if it can be rescinded. You can help with the costs of the judicial review too, with a donation.

The GTS have caused this latest splurge of newspaper articles because they asked the head of NHS England (Simon Stevens) to write to the PSA and share his thoughts about SoH accreditation - and he did, and it has caused quite a stir. I'll remember this next time I see homeopathy advocates saying that skeptics have no influence ;)

1. Daily Mail
NHS chief Simon Stevens blasts homeopathy as 'dangerous' and blames the industry for fuelling antivaxx myths
27 October, 22:01
They broke this story with a front-page which is itself a lovely surprise.

2. The Times (article)
NHS chief wants homeopathy to lose official stamp of approval
28 October, 00:01

3. The Times (editorial)
The Times view on calls to revoke accreditation of homeopathic practitioners: Bad Medicine
Homeopaths can cause great harm and deserve to be stripped of their accreditation
28 October, 00:01

4. The Guardian
Head of NHS voices 'serious concerns' about homeopathy
28 October, 07:51

5. BBC
Health bosses' 'serious concerns' over homeopathy
28 October, 10:57 (based on link's first appearance on Twitter)

6. The Independent
NHS bosses bid to blacklist ‘bogus’ homeopathy amid fears of anti-vaccine misinformation
28 October, ~12.31pm (based on the article's author's tweet)

The story has also spread into specialist news stories including The BMJ (Homeopathy should have professional accreditation revoked, NHS leaders urge, 29 October) and the Pharmaceutical Journal (NHS England expresses concern over accreditation of homeopaths, 29 October) and Google News lists plenty of other places where it's been published.

Background
With activism there are always two things - the meat* and the marinade. The meat is the big-change stuff like policy changes, regulatory action and so on whereas the marinade relates to the background in which opinion towards a topic changes. Both support each other.

With homeopathy it's become very clear that in the last few years there have been an increasing number of negatively-framed newspaper articles on the topic, a notable comparison with articles in previous years which were often rather fawning towards homeopathy and other alternative medicines.

It feels like it might have reached a bit of a peak this week with a front cover on the Daily Mail (which is finally pivoting towards encouraging parents to vaccinate) criticising homeopathy.

Apparently there may be some more stories in the pipeline on homeoprophylaxis though possibly Brexit and election news have taken over for now. Anyway I've written a Wikipedia article on Homeoprophylaxis just in case.

Three days after news of Simon Stevens' letter to the PSA broke the SoH had not issued any response - no news story on their blog, no tweet or Facebook post and they've either declined to comment to the authors of these articles or not replied as far as I can tell.

Inexplicably the British Homeopathic Association published a short piece bemoaning the latest crop of news articles but much of it is mistaken or incomplete so I'm not sure that helps much.
*or meat substitute for veggies or vegans!

Homeopaths are delighted that a draft report has been released - not sure why

tl;dr - Homeopaths are cock-a-hoop that a report has been released containing the phrase "encouraging evidence" (for homeopathy) but several mentions are just saying that "the term 'encouraging evidence' has not been defined" and highlighting problems with the conclusion. There are 6 'positive' mentions (in favour of homeopathy) in the report. All have been corrected with an annotation highlighting that it was a mistake.

---

Here's the draft first report from 2012, it's 294 pages long (293 pages plus a one page statement at the front from the NHMRC's CEO Anne Kelso saying that -

"NHMRC strongly encourages interested members of the community to refer to the 2015 NHMRC Information Paper: Evidence of the effectiveness of homeopathy for treating health conditions. Contrary to some claims, the review did not conclude that homeopathy was ineffective. Rather, it stated that “based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective.”"

The 2015 report (all 2015 docs can be found here) has an accompanying statement with some fairly strong warnings about NOT using homeopathy.

Table of Contents
1. How frequently does the phrase "encouraging evidence" appear?
2. How does the phrase "encouraging evidence" appear?
3. Full details of how "encouraging evidence" is used on each page - 13 to account for
4. Conclusions and rationale for this post
5. Background to the report
6. References
7. Screenshots of search strategy and results

1. How frequently does the phrase "encouraging evidence" appear?
Searching in the 2012 draft report (using Ctrl+F or Command+F on a Mac) for "encouraging evidence" brings up 12 mentions of 13 instances (one isn't picked up in the automatic search). Four are on p9, one each on pages 10, 11, 12, 54 and 236 with two instances on pages 85* and 138. By the way there are also 25 mentions of "no convincing evidence".

*Of the two mentions on p85, one is not picked up by the search. One is a mention, the other an annotation cancelling it.

2. How does the phrase "encouraging evidence" appear?
There is a rough split between statements in the report suggesting that there is encouraging evidence for homeopathy and statements that are annotations, highlighting that the conclusion was incorrect. It's not a 1:1 mapping of a positive phrase with a negative annotation because other phrases are also used (eg "See comments on issues with this section of the report on page XX").

Seven mentions are positive (all are corrected with annotations), 2 are neutral and five are negative. 

Three instances of the negatives say
"The term 'encouraging evidence' is not defined in this report. There are inconsistencies as to how it is interpereted." - examples found on pages 9, 85 and 138.

3. Full details of how "encouraging evidence" is used on each page - 13 to account for
All page numbers are those counted in the PDF by Adobe eg p10 of 294 refers to page "ix" in the document and p85 of 294 is actually page 72.

3a. Page 9 - four mentions
Page nine says that there is encouraging evidence for the effectiveness of homeopathy (one mention) for fibromyalgia, otitis media, post-operative ileus (first time to flatus), upper respiratory tract infection (URTI) in adults and side effects of cancer treatment. All are given 'Grade C'. The annotations (two mentions) point out the flaws - that 'encouraging evidence' isn't defined and that Grade C has sometimes been used to mean 'encouraging evidence' and sometimes 'no convincing evidence' so it has been applied inconsistently.

The last mention is the phrase "listed above under encouraging evidence [Grade C]" which I've taken to be a neutral statement (one mention).

3b. Pages 10-12 - three mentions
Context: Table 1 in the report is a 'Summary evidence of effect of homeopathy by condition' for 27 conditions. The phrases "no convincing evidence", "inconclusive / equivocal evidence", "insufficient evidence to reach a conclusion" or "no evidence" appear next to all but two.

Page 10
Cancer treatment symptoms (one of three mentions) says that there is encouraging evidence for topical calendula and Traumeel S. The annotation says "See comments on issues with this section of the report on page 40". [NB page 40 = p53 of 294]

Page 11
Fibromyalgia (two of three mentions), annotated with reference to page 70. [NB page 70 = p83 of 294]

Page 12
Upper respiratory tract infections (URTI) (three of three mentions) - annotated with reference to page 139. [NB page 139 = p152 of 294]

3c. Page 54 - one mention
There is one positive mention of "encouraging evidence for topical calendula... and Traumeel S" but this is then trashed in the comments. The annotations are a bit brutal including "incorrect - see below" and "The conclusions for topical calendula and Traumeel S cannot be justified AND WERE NOT CONFIRMED BY THE EXPERT COMMITTEE" (their capslock). The annotations also point out that the Traumeel S study was based on a small clinical trial of 32 participants. I don't think they're very impressed.

3d. Page 85 - two mentions
One mention of encouraging evidence for fibromyalgia treatment with a Grade C given. The other mention is the annotation saying that the term isn't defined and is inconsistently interpreted. Another annotation says that "this conclusion is flawed" and goes on to say that it should be a D.

3e. Page 138 - two mentions
One mention suggests encouraging evidence for postoperative ileus and this is immediately thwacked with "not defined / inconsistencies".

3f. Page 236 - one mention
This part of the report contains all abstracts of all the references considered / used, with a comment below.

"Although there is some encouraging evidence for hypnosis, herbal medicine and acupuncture..." - homeopathy is not actually included in this bit at all. It is subsumed into the phrase "there is insufficient evidence to suggest that other CAMs are effective for the treatment of childhood conditions". Pleasingly this is one of Edzard Ernst's papers (Ref 43).

4. Conclusions and rationale for this post
So there we have it. The draft first report, released to such fanfare from homeopaths, does not support homeopathy. The NHMRC does not recommend its use in any condition. Since homeopaths will probably try and use this report to suggest that regulatory bodies should loosen their restrictions on homeopathy (eg NHS and RCVS) I thought it best to have something to point people to saying why this is pointless.

5. Background to the report
A few years ago an Austrlalian study was commissioned by the NHMRC to examine the evidence relating to the use of homeopathy to treat a variety of health conditions. There were a number of problems with the draft of the 2012 report - it included studies of lower quality and was not clear about how it graded the quality of studies.

A second report was commissioned, and later published in 2015 and concluded that the evidence for homeopathy was not impressive. Hardly a surprise given that pretty much all overviews of the evidence come to the same conclusion.

Homeopaths were annoyed that the earlier 2012 draft report wasn't published. They were under the impression that the first report had shown some success for homeopathy and that this had been deviously edited out in the second report, unfairly implying a negative effect for homeopathy.

The first draft report has now been released and homeopaths are very happy that the phrase "encouraging evidence" appears in the document, such as -

"...in which the author concluded that there is “encouraging evidence for the effectiveness of homeopathy” in five medical conditions." ⁽¹⁾

It would be more correct to add the word 'wrongly' or 'mistakenly' between 'author' and 'concluded'.

Appended at the start of the draft report is a statement from the CEO of the NHMRC, the text of which is at the top of this post. The HRI has managed to draw this conclusion from it -

"We also welcome the valuable clarification provided by NHMRC CEO Prof Anne Kelso, that NHMRC’s second Homeopathy Review published in 2015 “did not conclude that homeopathy was ineffective”, despite claims to that effect in media reports and by anti-homeopathy campaigners." ⁽¹⁾

Incidentally there is an important but subtle difference between these two statements
1. There is evidence that homeopathy does not work
2. There is no evidence that homeopathy works

6. References and further reading
(1) NHMRC finally release first report on homeopathy (27 August 2019) Homeopathy Research Institute https://www.hri-research.org/2019/08/hri-statement-on-release-of-first-report-by-nhmrc/

See also Hinner Feldwisch's thread https://twitter.com/hfeldwisch/status/1166440559386517510

7. Screenshots of search strategy and results
Click to enlarge any that need it.

Ctrl+F or Command F brings up the Find option

Click the gearwheel to bring up the full search options

This is what I searched for in the document - encouraging evidence

There were actually 13 instances but only 12 appeared in the automated search. All are accounted for in my post.

The annotations for page 9 were particularly brutal.

I've created a Wikipedia page for the Society of Homeopaths

A few months ago I spotted that the British Homeopathic Association (BHA) and Faculty of Homeopathy (FoH) had Wikipedia pages but the Society of Homeopaths (SoH) didn't and I'd been meaning to create a page to redress that. It's been interesting revisiting some of their activities and with their recent re-accreditation by the Professional Standards Authority (PSA) and the Judicial Review into that decision that has been requested by the Good Thinking Society I thought it was time to get a move on, so here it is: Society of Homeopaths.

The BHA's page begins with a paragraph about when the association was formed and by whom, then highlights that homeopathy is an unevidenced pseudoscience before going on to highlight two examples of BHA's activities. The first is about the quality (apparently not great) of the evidence they submitted to the House of Commons Evidence Check on Homeopathy from 2009, the second is about their failed Judicial Review of NHS England's decision to top funding homeopathy.

I followed the same pattern for the SoH page and so far I have the following information in there.

• An Advertising Standards Authority (ASA) adjudication against the SoH in 2013 for engaging in false advertising and discouraging people from seeking essential treatments
• SoH considered legal action in 2016 against the ASA after it wrote to UK homeopaths to remind them of the rules for marketing material, but they were advised against it by their legal advisor
• In 2017 skeptics* complained to the PSA about the SoH as their members were offering CEASE therapy for autism. The PSA put some obligations on the SoH in place but re-accredited them. One of the obligations was to publish a position statement on CEASE (and monitor risks from member homeopaths offering this).
• In May this year there was an undercover interview by The Times with a number of homeopaths one of whom was both a member of the SoH and also offering 'homeoprophylaxis' (an alternative to vaccination, which doesn't offer any protection). Rather than bring about disciplinary proceedings the SoH defended the member and said they would complain to the press regulator.
• As a result of the PSA re-accrediting the SoH (on 1 April no less) the GTS has filed a request for a Judicial Review to be undertaken of that decision, you can read more about that here (and donate to the crowdfunder).

*the term skeptics refers not just to bloggers and activists by doctors, scientists, healthcare professionals and patients who are concerned about health claims.

Next to investigate, write, reference and add are

• Info on the 2006 Newsnight undercover 'sting' into homeopaths offering homeopathic alternatives to malaria prevention medicine, alongside a lack of general advice about bite avoidance. Some of the homeopaths involved appear to have been SoH members (a spokesperson from the SoH certainly appeared on follow-up programmes). This will take time to unpick as I need to remind myself of the sequence of events, and of SoH's involvement.
• Related to the above, a year later in 2017 blogger @lecanardnoir wrote a post about the SoH's response about their members re: the malaria sting and received a legal letter asking him to remove his post (which he did). Doing so triggered a chain of events resulting in the mirroring (copying, republishing) onto over 60 other sites and was probably the first time I hear the phrase the Streisand Effect (in which by seeking to hide information you end up drawing more attention to it).
• A retrospective link to this 2014 article which appeared when the SoH first began to be accredited by the PSA, pointing out how ill-advised this seemed.
  "It’s unscientific for a medical regulatory body to give accreditation to homeopaths" - New Statesman (18 September 2014)

Obviously I want the Wikipedia article to be reasonably encyclopaedic (kind of the point!) but I don't think it's necessary to itemise every single thing. Here are some things I've not added, or only lightly referenced.

• I've added the latest (as at Sep 2018) official number of society members (according to PSA's accreditation document) but struggled to make sense of the membership numbers overall so haven't included further information. Their current 'About us' website page has 1,200. In their 2009 submission to the HoC EvCheck they give it as 2,500, in 2013 it was 1,300.
• Probably I won't add anything about the problem of Lady Margaret Hall at Oxford University letting the SoH have their conference and AGM on site despite concerns about legitimising homeopathy, not to mention how the university's autistic students might feel about that happening. 
• Also there's some stuff about alleged links between a (former) SoH staff member and the long-since debunked MMR-autism controversy but that might require legal considerations, so probably best left out for now.
• The SoH has today published a news article on the fact that members can add additional therapies to their insurance package. Some SoH members offer a range of services, including homeopathy, but the standard insurance covers them only for homeopathy. Whether or not society members are underinsured might be a bit niche for Wikipedia.

The purpose of this post then is to combine some stuff that's on Wikipedia with stuff that isn't. I think it's important and helpful to have overview information of a topic, particularly where something involves many years of historical skeptic activism. It's easy to forget things and so useful to keep it all together.

Homeopathy company in Germany issues lawyerly notices to skeptics for saying homeopathy doesn't work

Yesterday I read a new post from Edzard Ernst highlighting that a homeopathic company in Germany, Hevert Arzneimittel, had sent legal letters to homeopathy skeptics asking them to stop saying that homeopathy doesn't work and to sign an agreement to that effect or they'd have to pay just over 5,000 euros to the company.

A couple of the German skeptics affected have tweeted copies of their letters. Some Twitter apps / platforms have a 'translate' button below tweets, if not you can paste the text into Google Translate and select German to English.

In early May another homeopathy group reported Bernd Kramer to the German press association for his criticisms of homeopathy, which he tweets, and he adds updates to his thread eventually leading to the tweeted legal letter from Hevert shared on 16 May 2019.

On 24 May Natalie Grams (herself a former homeopath) tweeted her own legal letter (English translation), by which time tweeted responses to @HevertNatur's Twitter account had become robustly critical and mocking, and voluminous.

As far as I'm aware people who received the letters had not been critical of the company itself, they'd just pointed out that homeopathy doesn't work.

Given the phenomenon of the Streisand Effect (drawing even more attention to something when seeking to remove some small level of attention already received, see also Verschlimmbesserung) it seems an odd action to take, as lots of people are now sharing info about the legal action. As a consequence they are now criticising the company as well as reiterating that homeopathy does not work with the rallying cry "Homöopathie wirkt nicht über den Placebo-Effekt hinaus" or "Homeopathy does not work beyond the placebo effect".

Today Hevert has published a statement on its Facebook page (though not mentioned at time of writing on its Twitter page) explaining the action it has taken in trying to prevent criticism of homeopathy in Germany. It's interesting to note that they specifically acknowledge the effectiveness of UK skeptics^ in getting legal restrictions introduced on homeopathy* in Britain, which followed from commentary that was critical about homeopathy (a pattern they are hoping to avoid occurring in Germany). Again the (over 200) comments on the page are now critical of the company's actions and asking for evidence that homeopathy is more effective than placebo.

The comments on Edzard's post are interesting and helpful and put things into context in terms of German law. Commenter Joseph Kuhn suggests that the company may be able to assume that, legally, authorised homeopathic products are considered effective: "The German law on drugs assumes efficacy for authorised homeopathic remedies (remedies with an indication)" and so perhaps it's not unreasonable to expect people to respect that assessment.

Eppur (non) si muove, however.

^this includes scientists, doctors, patients - not just bloggers
*For example homeopathy has largely been removed from the NHS and is no longer allowed as a first line treatment by vets. There's also been a tightening of permitted marketing claims and much greater scrutiny of them.

The Professional Standards Authority has re-accredited the Society of Homeopaths - CEASE therapy for autism

Reaccreditation document (PDF)

This one is a little surprising. A number of us have been expressing concern to the Professional Standards Authority (PSA) about the response by the Society of Homeopaths (SoH) to those of their members who are offering "CEASE" therapy for autism.

The SoH keeps a register of its 997 members (at Sep 2018, all of whom are allowed to use the term RSHom in their marketing material) and the PSA accredits a variety of society registers, including SoH's. SoH therefore runs an Accredited Register (AR) of homeopaths, though accreditation isn't meant to imply that homeopathy works.

Last year the PSA re-accredited the SoH with some provisos that the society would need to satisfy some additional monitoring requirements about those of their members offering CEASE.

Yestesrday the PSA published the latest accreditation and I've not read it all yet but wanted to add something here about it as I've written several times on this topic.

The 21 page PDF from the PSA is here - Society of Homeopaths Annual Review 2018

What surprised me is that the PSA highlighted a problem with members of an AR offering any treatment (whether real or bogus) that claims to treat a protected characteristic such as autism. The SoH still has members offering this, with a range of claims.

Thanks to @UKHomeopathyReg for alerting me.

Also of interest and relevance is that the Advertising Standards Authority (ASA) has referred five homeopaths (I don't know if any of them are SoH members, no reasons to assume that any are) to Trading Standards for further investigation. Last year the ASA sent an Enforcement Notice to 150 UK homeopaths who were making misleading claims to treat or cure autism. Homeopaths should not write CEASE out in full (it stands for Complete Elimination of Autistic Spectrum Expression) as the full name is an implied health claim, which is misleading.

Why so-called CEASE Therapy claims to 'cure' autism really have to stop - Guy Parker, CEO ASA

CEASE Therapy for autism in the UK news today - it doesn't treat or cure autism

1. Listen
The BBC will run a piece* early this afternoon on Radio 4's You and Yours about a bogus treatment for autism, called CEASE Therapy aka 'Complete Elimination of Autistic Spectrum Expression'.

Listen to it on BBC Radio 4 from 12.15pm today Friday 22 March 2019, or catch up later
https://www.bbc.co.uk/programmes/m0003d81

Read You and Yours' post about the story "Advertising watchdog rules fake autism 'cure' adverts must stop" https://www.bbc.co.uk/news/health-47666939

CEASE rests on the false idea that vaccination causes autism and uses homeopathy and supplements to try and "detox" children from the imagined negative effects of the vaccines. Not only is it nonsense it's also harmful and medically neglectful (encourages diarrhoea as a process to eliminate toxins),  a safeguarding concern (vulnerable children and families involved) and offensive (implying that autism should be eliminated). There is no need for it, and it's great that awareness is being raised.

2. Watch
The BBC also referenced CEASE on their Breakfast television show. You can watch it again on iPlayer (you may need to register) until tomorrow (Saturday, at 9.15am), from 19 minutes into the programme (6.18am on the programme itself).
https://www.bbc.co.uk/iplayer/episode/m0003fvb/breakfast-22032019

3. ASA
The Advertising Standards Authority's CEO Guy Parker published a blog post today about the action the ASA has been taking against homeopaths who are offering CEASE therapy and who are referencing it in relation to autism. Last year the ASA sent out an Enforcement Notice to 150 CEASE homeopaths pointing out the problems with offering the therapy, this notice has also been published today. Five homeopaths have been referred to Trading Standards but not yet added to their Referrals page.

Why so-called CEASE Therapy claims to 'cure' autism really have to stop
https://www.asa.org.uk/news/cease-therapy-claims-must-stop.html

Metro have also picked up the story.
Guardian too.

The ASA have previously adjudicated against two practitioners offering CEASE therapy - Teddington Homeopathy
and Elle Fox (trading as Bubbling Life).

4. SoH / PSA
The Society of Homeopaths is one of several membership societies for homeopaths but is the only one regulated by the Professional Standards Authority. SoH members are already required to adhere to ASA's guidelines but last year the PSA had to step in and address problems with some members' claims about CEASE.

The response by the SoH to the ASA's action has been described as "staggeringly inadequate" because there have been "discussions taking place on how the therapy might be renamed" instead of addressing the underlying nonsense. This merely "(e)ncourages CEASE quacks to continue as before, while hiding from ASA." 

Today (and over the weekend) Oxford University's Lady Margaret Hall is hosting the SoH's AGM and conference (on fertility and pregnancy).

5. See also
• CEASE Therapy on Wikipedia
• Westminster Autism Commission (PDF) on other harmful interventions on autism (CEASE not included)

*"We report on what's being done to stop a bogus treatment which claims to cure autism in children. The Advertising Standards Authority has told You & Yours it’s served enforcement notices on 150 homeopaths who offer so-called CEASE therapy. The treatment claims to purge heavy metals, vaccines and antibiotics from a child’s system. The National Autistic Society says there's no cure for autism and it's wrong to claim it can be cured. We speak to a mother who tried the treatment for several months and now regrets it. The Society of Homeopaths say there are discussions taking place on how the therapy might be renamed to make claims aren't made that can't then be substantiated."

A new Wikipedia page on CEASE therapy

Summary: I've created (with help from other Wikipedians) a new page on Wikipedia for CEASE therapy giving a brief overview of what the therapy involves and the regulatory action that's taken place against the misleading claims made for it. (Page last updated - 29 July 2018)

https://en.wikipedia.org/wiki/CEASE_therapy

For some time I and others have been trying, not all that successfully, to get UK homeopaths / naturopaths to stop making misleading claims about curing or treating autism. The information accompanying their treatment promotes the idea that vaccines cause autism (which is a harmful idea to be promoting anyway) and the treatment itself involves the notion of 'vaccine detox' through large doses of vitamin C alongside a buffet selection of supplements, dietary restrictions and homeopathy. CEASE therapy (Complete Elimination of Autistic Spectrum Expression - the name itself is problematic) is promoted to parents of children with autism and no evidence has been provided of it being of use to anyone. A related 'treatment' is Homeopathic Detox Therapy or HDT.

In 2015 Teddington Homeopathy was reported to the Advertising Standards Authority (ASA) for misleading CEASE-related claims and the ASA adjudicated against them and subsequently added them to their non-compliant online advertisers list. [I submitted a complaint myself but the ASA had already begun to take action based on someone else's prior complaint].

More recently we have asked the Society of Homeopaths to rein in their own members. There are several homeopathic societies in the UK and the SoH has its members' register accredited by the Professional Standards Authority (PSA) so I suppose this offers a potential source of leverage. Happily the PSA listened to our* complaints and imposed conditions on the SoH when reaccrediting their register. The SoH published a position statement advising their members to take care about misleading claims relating to the treatment.

In my own complaint, to the SoH, I reported five of their members who had been making misleading claims, then I periodically monitored the five websites for any changes. Sadly the changes were fairly minimal - hence the 'not all that successfully' reference above. Most significantly one member has cancelled their SoH membership (so they are no longer required to follow the SoH's guidelines on marketing etc) but very little of the text has changed.

In July 2018 the ASA adjudicated against another CEASE therapist who offered CEASE among several other things, so it wasn't the main focus. I also discovered that they'd written to several homeopaths in May and June enclosing an Enforcement Note on CEASE therapy and asking them to ensure that their marketing material did not make misleading claims.

Hopefully the ASA might take some action on these and other homeopaths - I won't necessarily know about it because they do not need to adjudicate further on any homeopath. After several cases the ASA already knows that there's no good evidence for homeopathy and that it doesn't work so there's no point in revisiting the evidence and adjudicating. Instead each new complaint about homeopathy is handled by the Compliance team who, frustratingly, don't publish their activities. I don't think any of the homeopaths (from my complaint) have been selling homeopathic remedies in breach of the Medicines and Healthcare Products Regulatory Authority (MHRA) regulations.

Since getting regulatory bodies to take action on misleading health advertising is a long, slow process I thought I'd try a parallel approach of creating a new Wikipedia page about the therapy. Wikipedia's pages can feature prominently in search engine results so I'm hoping that the page might appear when families are searching for information. No guarantees of course! No sign of the page in search results yet but it's only been 24 hours.

*our - I did put in a complaint however the timeline was such that the PSA had already had its meeting and taken action before I did, so mine's unlikely to have contributed much to the outcome.

After writing about the new Wikipedia page on Twitter I got a fair bit of push back from homeopaths and CEASE therapists who get a bit cross when anyone points out that they're making unsupported claims about an implausible treatment. One of them created a new account with a username that is typical of the lack of insight of some homeopaths I've spoken to (see screenshots below). Of course this certainly seems a bit intimidating and might put people off from writing about their activities on Twitter but it doesn't actually stop people from undertaking those activities (or getting other people to mention them instead).

Is it really like that I wonder ;)

A few more screenshots below.

There's still a lot to be done on CEASE. Getting the ASA and SoH to persuade homeopaths to remove misleading claims is only one small part. They are still attempting to treat children with autism which is beyond their level of competence and a safeguarding issue. The MHRA can block the sale of the 'remedies', local councils can take action around safeguarding and Trading Standards can prosecute.

 

The Society of Homeopaths agrees that it's unethical to claim to cure autism with CEASE

Pic credit: Water, aka Abstract Aqua Background from Pixabay

Several people have complained to the Society of Homeopaths (SoH) about their members (lay homeopaths with no medical training) making claims on their websites to cure or treat autism in children using a form of treatment (CEASE therapy aka Complete Elimination of Autistic Spectrum Expression). The treatment is likely to cause harm to these vulnerable customers.

After my own complaint to the SoH (Nov 2017) I kept an eye on the five websites I'd reported but when no changes were made to any of them that would have addressed my complaints I raised the matter with the Professional Standards Authority (PSA). The PSA accredits the SoH's members' register (people who are entitled to call themselves RSHom).

For the latest round of reaccreditation the PSA imposed a condition (as well as some suggested recommendations) on the SoH with the risk that their accreditation would be cancelled if the condition wasn't met. This was the condition -

"The PSA panel imposed one condition (p2 of the document linked above) - to improve governance on CEASE therapists and advertising (if this is not met then accreditation may be rescinded). The condition has three parts: (i) a position statement on CEASE therapy and on its advertising by homeopath members, (ii) develop some mechanism to ensure that homeopath members offering CEASE don't breach the Society's Code of Ethics, (iii) review the risks relating to CEASE therapy (and other treatments too)." Source: Better monitoring of homeopaths advertising CEASE therapy for autism in the UK - hooray (my earlier post).

On Friday 25 May the PSA wrote to me to let me know that the SoH had met this condition, and that they had published a position statement on their website making it clear that homeopaths should not claim that they can cure autism and that writing out the full name of CEASE therapy (Complete Elimination of Autistic Spectrum Expression) is problematic as the name itself implies a cure

"A number of Society members have been trained in CEASE and make reference to it in their marketing. While this is acceptable, members should be aware the title, meaning ‘Complete Elimination of Autistic Spectrum Expression’ is misleading. RSHoms must not suggest that they are capable of a complete cure of autism as this would be unethical and in breach of the Code of Ethics.

The Society does not endorse any aspects of CEASE therapy contrary to NHS guidance and nor should RSHoms. In particular on vaccination, homeopathic prophylaxis, and the use of dietary supplements. It is beyond standard homeopathic practice to provide advice on the use of supplements and therefore any guidance given should be in line with the NHS Guidelines." SoH's position statement

As far as I can tell ALL aspects of CEASE therapy are contrary to NHS guidance and there is no mention of the fact that homeopaths have no business treating anyone with autism. Hopefully after the Bank Holiday the SoH will communicate this update to the relevant RSHoms.

I'm not sure how long it will take though for the misinformation to be removed from the homeopaths websites though.

I can't actually take any credit for this because the complaint I put in to the PSA was after they were well along in their decision-making on the conditions for the SoH's reaccreditation. Much of the credit goes to @UKHomeopathyReg (blog) who has also kept the media (both in UK and North America) informed of the problem of homeopaths attempting to treat autism. Stopping homeopaths from claiming to cure autism is one (good) thing but raising public awareness that they've never been able to do this goes along way too.

Further reading
More than 120 homeopaths trying to ‘cure’ autism in UK (27 April 2018) The Guardian
Exclusive: the ‘cure’ involves detoxing children of vaccines and antibiotics held responsible for the condition

Complaints levelled at B.C. naturopaths offering 'complete elimination' of autism (24 May 2018) CBC
3 practitioners offering unproven therapy are subjects of complaint to College of Naturopathic Physicians

Further background
The Society of Homeopaths has a register of homeopaths (who may use the title RSHom) and this register is accredited by the Professional Standards Authority. Accreditation does not, and is not meant to, imply that homeopathy is a valid system of medicine (it isn't), simply that the people who've signed up to be RSHoms have insurance and have agreed to follow a code of ethics.

Since the general public may not realise what accreditation means (perhaps believing it to be more of an endorsement than it actually is) there have been a lot of raised eyed mutterings over the strangeness of accreditation.

Some RSHoms (and some other non RSHom homeopaths) claim that they can cure autism by using CEASE therapy. The treatment is potentially very harmful to children with autism, requiring them to take dietary supplements (including high doses of Vitamin C) as well as following a restricted diet. The use of homeopathy alongside this is a bit of a red herring, it is just one component but not the main thing.

Children with autism are vulnerable, as are their parents and carers, to harms done by well-meaning people who offer bad advice. There are concerns that these homeopaths are acting well beyond their competency and putting kids' health at risk - this is really a safeguarding issue. I've no idea if the therapists have appropriate training in caring for children with autism or have passed the DBS check.