Scottish GPs use of homeopathy

The conclusions reached in the article by Ross et al.[1] are very unhelpful. In ‘What is already known about this subject’, you state: ‘Doctors and regulatory authorities have expressed concerns about their efficacy and safety’. What concerns have been expressed about the safety of homeopathic medicines? There are no published studies which have ever recorded harms from homeopathic medicines. To state that there are concerns about the safety of homeopathic remedies is erroneous and, I suspect, deliberately misleading. I wonder about the authors' motivation in conducting this study. They are clinical pharmacologists, after all, not experts in either Primary Care or Homeopathy, despite their claims to know better than the 60% of Scottish general practitioners (GPs) they accuse of acting either carelessly or inappropriately (see McLay's remarks as reported in the Glasgow Herald, 2 December 2006). It is considered to be good publishing practice to make a statement about conflicts of interest and funding, but, in this case, no such statement is declared.

It is particularly unfortunate that the authors confuse and conflate homeopathic and herbal prescribing. These two therapies are completely different. Combining them as a single entity obfuscates rather than clarifies.

The so-called ‘widespread concern’ about efficacy of homeopathy referred to appears to be a reference only to the Shang paper in the Lancet[2]– a seriously criticised paper on the basis of its poor and obscured methodology [3, 4]. There are many other studies of the evidence base for homeopathy available and none of them is quoted here, probably because these other studies tend to favour the conclusion that homeopathic treatment is probably effective in some conditions and cannot be explained simply on the basis of placebo [5, 6].

This study only records the incidence of prescribing and makes no attempt to determine the effectiveness of these prescriptions, nor to analyse their safety. So, how can any conclusion be reached that GPs' use of homeopathy is either to be praised or condemned?

How bizarre to suggest a possible explanation for the greater use of homeopathic remedies in younger patients was to use a placebo for the ‘worried well’. The median age for homeopathic prescriptions quoted is 48, and the top five conditions of injuries, joint symptoms, cramps, PMT, menopausal symptoms and breast feeding problems should surely not be dismissed so arrogantly as problems of the ‘worried well’.

The authors would appear to be unaware of the substantial amount of clinical evidence in favour of homeopathy and of the research into ultra-high dilutions which scientifically demonstrate that expecting such preparations to have a biological effect is not unreasonable, illogical or unscientific. In fact, the conclusions of this group are illogical and unscientific [3, 7, 8].

The issue of safety is not studied in this research at all and if, as GPs would claim, very safe homeopathic remedies can be as clinically effective as more potentially dangerous and more expensive pharmacological substances, then should not such prescribing be supported?

On the issue of the use of evidence-based treatment in the NHS, the authors might like to re-acquaint themselves with the BMJ's Clinical Evidence, which states in its introduction that of the 2500 treatments considered, 47% are of unknown effectiveness and that ‘most decisions about treatments still rest on the individual judgements of clinicians and patients’[9].

What really is the purpose of this study? Just a platform for some clinical pharmacologists to express their prejudices? All this study tells us is that a very large number of Scottish GPs are using their professional judgement to prescribe homeopathic medicines for a wide range of their patients.

RL is employed by NHS Greater Glasgow which provides homeopathic consultations on the NHS. NHS Greater Glasgow has contracts with most Scottish Health Boards for homeopathic services.