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?'.
----------------------

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

Health charity conferences: policy thoughts on liveblogging

Unless I can do some impressive editing, I'm brewing the world's largest blog post (already at 12 pages but I suspect I'll soon come to my senses).

It's really a guide or perhaps even a 'policy document' full of suggestions and practical tips on liveblogging (from the perspective of conference organisers at a health charity organising a conference for researchers and healthcare professionals) based on my having attended a few conferences where liveblogging / livetweeting has been done, and a fair bit of reading others' experiences online.

Hopefully the following are fairly standard but if I've missed anything please comment below or via Twitter (@JoBrodie).

Pretty much all of the recommendations and thoughts below are explained further in the large document, but I thought I'd drip feed this first to see if people disagree with the direction. I'll spruce them up for the final document, just 'getting them out there' for now :)

Some of my suggested recommendations
Decide if you are going to have a policy about liveblogging or leave things to take their own course. At the very least have a bit of a think about how your organisation might engage with delegates who blog about your conference, thinking about the (many) advantages and the (probably small) potential drawbacks.

Your policy might be of the type where you state that you will ask all delegates NOT to tweet (boo) or that you will leave well alone (yay, but only up to a point), but it's a lot better if it's nuanced and offers a 'code of conduct'. It also helps if it's findable on your website. It will undoubtedly benefit from input from staff in conference/events teams, social media people, science /research teams.

Develop an internal policy on how you will deal with any problem tweets or twitterers (unlikely, but not a bad idea to think through some eventualities) – ignore, engage, countertweet etc.

Assuming liveblogging will not be blocked, include in it a basic list of suggested Dos and Dont's for your conference (this may change depending on the type of conference). Encourage people to tweet appropriately and perhaps provide information on signing up to Twitter (eg see Twitter's help pages), or how to start a blog. Recommend that people use their real name so that others can find them but remind people that Google has an uncanny ability to record everything, so best not to pick fights.

Decide on a sensible hashtag, taking smartphone users into account. Remind people that their tweets can have greater reach if they pepper their tweets occasionally with the tagged health condition too, eg #cancer, #diabetes, as people will be following those words too.

Publish the hashtag on all conference material and refer people to your policy on conference liveblogging either on the web, or include a page in delegates' packs. Begin using the hashtag a few days (or weeks, if a major conference) before the conference so that the channel has content when people start to look for it, and to help build up a buzz about the conference.

Find out information about the wifi availability in the conference centre and make sure your staff at the event know the login and password, and that info about this is included in the welcome preamble. If this information can be shared in advance with delegates so much the better – even if they are not tweeting many will want to access the internet and their emails.

When at the venue, if you want to be really nice, develop and maintain a list of locations of power sockets :)

Use one of the Twitter archiving tools to record all the hashtagged tweets, publish it on your website as a PDF and alert delegates to its availability.

Use the hashtag yourself in your own corporate tweets, and share useful links / retweet other useful posts.

If your conference involves a question and answer session then you can take questions from people 'watching' at home, increasing engagement and reach beyond the delegates present. A number of conferences have occurred where the audience at home was larger than the number attending, because of social media.

Think about whether or not you want conference tweets to be displayed on a screen in the foyer or behind the speakers, but maybe let the speakers know.

If your conference has industry people at booths / stalls is it worth also having a stall selling spare cables, chargers and other computer / smartphone paraphernalia?

How to transfer downloaded videos to iPhone

I found this page to be a really useful guide on how to do this. Probably that page is all anyone would need, but to add a bit to it I've included some screen shots of the system I use, which I hope are helpful.

If you've already got the files on your computer, jump to Bullet Point 7.

My computer is running Windows XP and I downloaded RealPlayer SP from Real which includes the RealPlayer SP Converter.

RealPlayer SP enables you to download any video that is either playing, or ready to play on the screen (a little pop up window appears giving you the opportunity to 'download now').

RealPlayer SP Converter can convert the downloaded video into a range of media, including .m4v files suitable for playing on an iPhone.

So the first step would be to download RealPlayer SP....

Once downloaded, pick a video you want to watch - for the benefit of nostalgia I chose the last ever outing of the ITV Schools Rotomotion logo from YouTube.

1. The 'Download this video' option appears ... highlighted in orange


2. Clicking the 'Download this video' link brings up the downloader, which looks like this

(Note that 'Convert All...' , to the left of Pause, is greyed out until the video finishes downloading.)

3. Once the video is downloaded, the programme will give you the option to convert it to a different filetype - that page looks like this - I've already selected the Apple iPhone option and where I want to store the video.


4. Because I've used it before it's already set to 'Convert to:' Apple iPhone / h.264 but there are other options, some examples of which are below


5. OKing the green Start button (in 3) starts the conversion process.


6. Once the file is converted you're given the option to save it to iTunes by clicking 'Add converted files to my iTunes library'.


7. If you've already got files on your computer and want to add them to the iTunes library, follow Step One of this page. iTunes does have its own converter - select a media file from within your library, right click and choose the option highlighted in red below.

8. To get the video onto your iPhone, connect it to your computer and wait for it to be recognised. Click on the battery icon that comes up next to the DEVICES menu (highlighted in green in the screen capture below) and this will bring up everything that's on your phone. Click the 'Movies' tab (highlighted in blue), tick the check box for your video (in orange), then apply (purple).

The phone will probably automatically sync, but if not, click File / Sync 'your phone'. Open he iPod icon on your phone, let the library update and your file should now be there.


I've heavily edited some of the screenshots so let me know if they're less useful than I think they are and I'll upload the full size versions to Flickr.

Strange case of the disappearing #homeopathy video? #ten23

Earlier today I watched a video which Debby Bruck posted to the #ten23 channel. It was very well presented, from a pleasant gentleman called Dr Bhatia - I thought he was quite a natural in front of the camera.

The video is no longer there however - the page has been deleted and a different video has been uploaded to YouTube - so I'm not able to prove any of the following comments, however I'm pretty sure that in the first few words that Dr Bhatia spoke, he referred to the 1023 campaigners / supporters as 'fools' and then went on to explain why he called them that.

Comments on that video were only possible if you are a member of the 'homeopathy world community' website, which I'm not - so I did the next best thing and added a comment via Google Sidewiki.

I remember writing that a part of the video, at 4 minutes in, was nonsense as it misdescribed diabetes. The copy of the video that is now circulating via YouTube mentions diabetes at the three minute point, and it also doesn't call skeptics fools. Did anyone download a copy of the earlier video?

Presumably, now that the video has been deleted it will have taken my comment with it - I don't think the deletion was anything to do with my sidewiki comment, perhaps someone just had a change of heart about calling people fools, tempting as that might be, or some other reason.

My original tweet (below) can be seen in context here
>>Nicely presented but I disagree, & have sidewikied #ten23 RT @DebbyBruck Dr Bhatia exposes absurdity in 10:23 campaign http://bit.ly/5J0IHf

The expanded version of that bit.ly tweet is http://www.homeopathyworldcommunity.com/video/masshomeopathicoverdoseflv-1 - however that now goes to a 'page not found' page.

Various tinkerings in Google confirms that the page did exist previously, however the new version of the video added to YouTube is called -mov not -flv, and advanced searching within the homeopathyworldcommunity site's cache doesn't yield the original flv vid.

Ah well... I don't think I'm losing my marbles ;)

I'm leaving the text that I Sidewikied to the YouTube video here, in white (sneaky) in case that too gets deleted and I need it again...

Campaign is not to do with disproving homeopathy

I am not aware of any good evidence showing that homeopathy works beyond placebo. The lack of evidence was made very clear at the House of Commons Science and Technology Committee's evidence check for homeopathy. The 1023 campaign is not really about disproving homeopathy further.

The campaign is raising awarenss that a pharmacy, which has already admitted that it has seen no evidence that homeopathy works (beyond placebo), is continuing to sell these products.

The part about diabetes is nonsense - people with diabetes are not in a hypersensitive state to sugar. They either lack the main glucose regulating hormone (insulin) or are less able to use it to regulate glucose. In a person without diabetes glucose will raise blood glucose levels but a series of regulatory mechanisms come into play quickly to regulate glucose, in someone with diabetes these mechanisms are less effective.

Yes but what's that got to do with anything?

'ltlmtnhomeopath' on the #ten23 'channel' recently posted the following:-

ltlmtnhomeopath NHS Evidence - #CAM http://www.library.nhs.uk/cam/SearchResults.aspx?tabID=289&catID=12423 #ten23 #homeopathy

There are 23 pages of information about CAM (but homeopathy is not mentioned on the front page, so why not link to where the homeopathy information is if it's mentioned on those pages). What is listed there relates to herbal remedies, acupuncture and the like.

During the writing of this post someone has looked at all the pages (more patience than me) and concluded:-

hywelowen @ltlmtnhomeopath: Actually, NONE of these 225 papers are about #homeopathy - no evidence there! http://bit.ly/4raYRa #ten23 #CAM

Here's what's on page one.

• Black cohosh (Cimicifuga racemosa): a systematic review of adverse events
  ...the abstract of which concludes "Black cohosh has been associated with serious safety concerns that urgently require further investigation."

• Acupuncture for tinnitus (Cochrane protocol)
  note - this is a protocol of how Cochrane reviewers will review evidence, but it doesn't really constitute evidence itself.
  "To assess whether acupuncture, either alone or in combination with other treatment, reduces the severity of tinnitus." - ie status unknown.

• Auricular acupuncture for opiate dependence in substance misuse treatment programmes (Cochrane protocol)
  Again, it's a protcol, about ear acupuncture I think.

• Coenzyme Q10 for Parkinson's disease (Cochrane protocol)
  Another protocol - evidence is, at time of publishing details of this protocol, undetermined.
  "To assess the evidence from randomised controlled trials for the efficacy and safety of treatment with Coenzyme Q10 compared to placebo in patients with early and midstage Parkinson's disease."

• Reflexology for treatment of constipation (Cochrane protocol)
• Rheum officinale (a Chinese medicinal herb) for chronic kidney disease (Cochrane protocol)
• Spinal manipulative therapy for chronic low-back pain (Cochrane protocol)
• Traditional Chinese medicine for preventing postpartum hemorrhage (Cochrane protocol)
  
  all of these are Cochrane protocols
  
  
• 2009 Annual Evidence Update on CAM in Depression - Use of CAM
  Unless I'm mistaken this study looks at the patterns of use of CAM by people with mental health problems, not whether or not it's effective, although the abstract does note that many people find it beneficial. The word 'homeopathy' doesn't appear anywhere in the summary listed on the page.

So posting this series of articles to the #ten23 channel would seem to be a bit of an own goal.

From what I've gathered about the #ten23 campaign it isn't about wiping homeopathy of the face of the earth, I don't think it's even about discrediting homeopathy (IMHO, a process already completed) but simply about releasing trained pharmacists from the ridiculous position of being asked to give advice about non-medicines, sold next to medicines, in a shop which has already admitted there's no evidence for their effectiveness but that it values patient choice...

I'm quite happy for people to carry on selling homeopathic pills in a non-medical setting. I'd rather they didn't but...

The NHS Evidence - CAM pages that actually do relate to homeopathy are here.

The third article listed (I picked the first one that mentioned homeopathy overtly in the title) wasn't too impressive.

• Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials
  "The review found no convincing evidence for the effectiveness of any therapeutic or preventive homeopathic interventions for the treatment of childhood and adolescent ailments."

Finally, I wish the homeopaths posting articles to #ten23 would make better use of the URL shorteners such as bit.ly, is.gd, tinyurl.com etc. as that way they'll be able to get more text in their tweets.

1023 or #ten23 campaign