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 'banned on the NHS' - nearly, but not quite

NHS England is updating its guidance to Clinical Commissioning Groups (CCGs), recommending that certain items offered in primary care should no longer be prescribed. This includes homeopathy but some herbal remedies are in there too, also glucosamine + chondroitin used (ineffectively as it turns out) for osteoarthritis pain.

The document outlining the recommended changes was published on 21 July 2017 and is called Items which should not routinely be prescribed in primary care: A Consultation on guidance for CCGs. It's out for public consultation until 21 October 2017 (see pg 7 of 48 of the linked docuent on how to respond).

A. Things I want to consider in this post, the short version
1. Has homeopathy been banned from the NHS? 
No, not yet

2. Is it likely that homeopathy will be removed from the NHS?  
Seems pretty likely

3. Homeopathy costs a fraction of the total NHS costs, why do skeptics want it removed?
The evidence isn't good, also to minimise any unwarranted positive associations with healthcare

4. Are there any reasons to keep homeopathy on the NHS? 
Slightly dishonest ones

5. What's been the role of skeptics in removing homeopathy from the NHS? 
Probably helped

B. Things I want to consider in this post, the longer version
1. Has homeopathy been banned from the NHS?
Not yet. The document acknowledges that the evidence for homeopathy is poor and that homeopathy should not be prescribed, however this is a consultation document not an edict. Also this will affect England, not the whole UK.

2. Is it likely that homeopathy will be removed from the NHS?
I think so - it's widely acknowledged that it's a waste of money and there is little support for it being on the NHS. To be fair homeopathy has been declining on the NHS for two decades as this bar chart from the Nightingale Collaboration. This is more tidying up loose ends than a big new thing.

3. Homeopathy costs a fraction of the total NHS costs, why do skeptics want it removed?
While it's true that the homeopathy spend is now under £100,000 (a drop in the ocean compared with total NHS costs) it's not just about costs. We don't want money wasted on unevidenced treatments (this includes pharma drugs too), even if it is only a small amount of money. But there's also the 'halo effect': homeopathy benefits by its association with healthcare, the NHS is effectively giving its backing to nonsense. Removing it from the NHS removes this positive association. Annoyingly homeopathy also benefits from the fact that you can buy it in many highstreet pharmacists but that's a different argument.

Booting #homeopathy off NHS not *just* abt saving relatively small pot of cash, but also removes 'imprimatur' of a +ve assoc w 'healthcare'.

— Jo Brodie (@JoBrodie) July 21, 2017

4. Are there any reasons to keep homeopathy on the NHS?
Not good ones, no. Some doctors have argued that patients who are distressed about perceived ill-health, despite not actually being unwell, might benefit from homeopathy or placebo pills.

TEETH

— UK Homeopathy Regs (@UKHomeopathyReg) July 23, 2017

"TEETH" stands for "Tried Everything Else, Try Homeopathy".


The idea would involve doctors knowingly (or perhaps even unwittingly) giving patients inert medication with the aim of making them feel better (placebo effects, being taken seriously etc) without causing any side-effects. Another possible benefit is keeping a link with a patient who might otherwise withdraw from appropriate healthcare and explore unhelpful and costly options from quacks.

To be honest I do have some sympathy with this notion. The dishonesty troubles me - it's basically lying to a patient 'for their own good' but I can see examples of where I might go along with this (which also troubles me!).

Here a GP writes about 'heartsink' patients (where your heart sinks as what's ailing them isn't clear, nor is the solution) in an article on the Faculty of Homeopaths website. The FoH is a society of medical doctors who are also homeopaths.

"Another group of patients for which homeopathy can be helpful is those who frequently appear in GPs’ surgeries presenting with a whole host of “functional disorders”. Despite undergoing the full gamut of blood and hospital tests, no abnormality in the body is found. Nevertheless, these “heart sink” patients are clearly suffering from pain and discomfort, which is blighting their lives. This is understandably frustrating for them, for they know full well something is awry but there is no medical evidence for this.

Sometimes conventional medicines can be useful, but once again they are symptomatic treatments which may also produce unpleasant side-effects, resulting in the patient feeling even worse. Homeopathy affords me another approach in trying to help these patients. It doesn’t work for them all, but I’m frequently surprised at how many it does help."
Source: https://facultyofhomeopathy.org/homeopathy-general-practice-2/

5. What's been the role of skeptics in removing homeopathy from the NHS?
The term 'Skeptics' is generally assumed to mean activist bloggers but obviously includes people who aren't bloggers but who are also skeptical of homeopathy - including scientists, doctors and other healthcare professionals, teachers, people who've tried it but experienced no real benefit from homeopathy, members of the public, anyone.

It's difficult to prove causality. My perception is that online skeptical activism, particularly targeted at homeopathy, really got going in the early-mid 2000s, coalescing around Ben Goldacre's Bad Science colummn and blog. Obviously scientists and doctors have obviously been skeptical of homeopathy pretty much since it was invented. Prof David Colquhoun has been blogging about homeopathy since the very early 2000s and published (in a journal) a re-analysis of some homeopathy data in a paper in 1990 - I'm sure others have too, it's just we happened to have a conversation about this recently!

The focus of skeptic activism can be both narrow and targeted (for example getting something changed, eg getting an advert taken down, getting an event moved from an academic setting etc) or wider (eg contributing to people's awareness of what homeopathy actually is) and I think both feed into each other. I think of the former as 'meat' and the latter as 'marinade' and I think skeptic activism has done both very well. It seems as if articles in the press about homeopathy are much more critical and less credulous than they have been in the past - I don't know if this can be attributed to skeptics but I know that quite a few of us have contacted journalists to point to better information.

In late 2009 the UK Government announced that it was seeking examples of topics in which a science Select Committee could "assess the Government’s use of evidence in policy-making", inviting the public to suggest topics. Homeopathy was one of many, and was chosen to be the second 'evidence check' resulting in a 2010 document recommending that funding be withdrawn.

The fact that homeopathy's been included in the current consultation is also largely due to the efforts of the Good Thinking Society which has mounted legal challenges to Clinical Commissioning Groups to get them to stop funding homeopathy, as well as trying to get it blacklisted from NHS spending.

Further reading
Skeptic successes in homeopathy (originally published 24 August 2015 but regularly updated)