The NHS budget for homeopathy is in the region of £4 million, with resources allocated between three NHS homeopathic hospitals and a number of NHS homeopathic clinics. Some homeopathically trained doctors take NHS referrals and some 400 GPs integrate homeopathy into their day to day practice, treating around 200,000 patients per year. In a recent consultation regarding the NHS Lanarkshire Centre for Integrative Care (formerly Glasgow Homeopathic Hospital), 80.6% of respondents supported referrals continuing. With resources stretched and Clinical Commissioning Groups having to make strong cases for the allocation of funds, what role does homeopathy have in the NHS?
As a user of homeopathy for nearly 25 years and a qualified practitioner for 15 of those, my personal and clinical experience is that homeopathy works. Additionally, having witnessed its efficacy in numerous babies and small children, and in animals, I have long since dismissed the idea that successful homeopathic treatment is simply the result of placebo effect. The purpose of this article is not explain homeopathy as a treatment modality, nor to defend it against its critics, but to illustrate, using two examples, where its benefits lie for those patients who want access to the choice in medical treatment that the NHS itself advocates, and a democratic society expects; and to suggest that the integration of homeopathic and conventional medicine could improve treatment outcomes and facilitate more effective use of resources.
Nine years ago my daughter, Annie (now 19), developed Henoch-Schönlein Purpura (HSP). As the illness progressed, her joints became increasingly swollen and every movement was excruciating. The analgesics prescribed with the acknowledgement of the paediatrician that they could potentially exacerbate the vasculitis in her gut, were ineffectual. With the GP unable to offer other treatment and unwilling to visit, I phoned our homeopath, who came to see Annie and prescribed Bryonia – a remedy that closely matched her symptoms. The pain improved dramatically, and with continuing effect. We discontinued the analgesia. A week or so later the purpura erupted as large, painful dark purple bullae. Again, painkillers were ineffective. This time, the symptoms matched the remedy Lachesis – made from the venom of the bushmaster snake. After a dose of Lachesis 200 Annie fell asleep and slept soundly through the night for the first time in over 2 weeks. Other remedies followed with equal success as her symptoms changed.
In all, Annie had two nights in hospital and a follow up visit to our GP. Beyond diagnosis, monitoring for complications, hydration and limited pain relief, Annie’s treatment was homeopathic. Although various conventional treatment regimens have been described for HSP, there is no consensus on the protocols. Treatment with corticosteroids remains controversial. In Annie’s case, analgesia was largely ineffective, while homeopathic treatment dramatically reduced pain, alleviated her symptoms and supported her convalescence. She seems to have fared better in terms of recovery time and subsequent health than other cases I’m aware of, for example regaining her mobility in a third of the time than did another family member, who had HSP resulting in long term renal problems, or the son of a GP friend who subsequently underwent a kidney transplant. She did not experience the recurrence of the illness that occurs in one in four patients.
In situations where the suitability or efficacy of pharmaceuticals is limited (a scenario that is set to become more commonplace as anti-microbial resistance is on the increase), homeopathy may offer more effective (and more cost-effective) treatment. All conventional medicine could offer Annie when she had HSP (beyond the diagnosis, monitoring and reassurance that we were very grateful for) was analgesia that did not work. Homeopathic medicines, however, were effective. Additionally, Annie benefitted from the presence of a practitioner she knew and was comfortable with, who was able to contextualise his assessment of her acute state in his knowledge of her overall health, and who was able to visit her at home. As a family in distress dealing with a frighteningly unwell child and with hospital environments that can feel impersonal and disempowering, homeopathy gave us back some sense of control, as well as the relief that treatment was proving efficacious and was safe and free from side-effects.
Rarely accessing NHS services, families like ours who opt for alternative health care slip beneath the radar in terms of treatment outcomes and cost analysis. Annie’s burden on the NHS has been minimal. She has rarely seen a doctor, never taken antibiotics and has rarely taken analgesia. Her birth (at home with independent midwives) and childhood illnesses (chicken pox, whooping cough, mumps, coughs and colds and an ear infection) were managed homeopathically. This degree of self-reliance is unusual in today’s highly medicalised culture in which individuals consult GPs and frequent emergency departments for even minor ailments. It is not, however, uncommon among individuals and families who prefer complementary and alternative medicine (CAM) and whose practitioners encourage them to take responsibility for their own wellbeing. As my patients become confident with homeopathic treatment, they increasingly make homeopathy their first port of call, keeping the overburdened NHS for times when allopathic diagnostic tools or treatment are really required.
For those individuals and families for whom private homeopathic treatment is not feasible financially, the NHS provides a valuable source of treatment that is sadly limited in availability and threatened by controversy and funding cuts. My second example describes the experience of a mother, incidentally from a medical family, who obtained a GP referral to the Bristol Homeopathic Hospital for her 8 year old daughter. Her account is as follows:
“The doctor had time to really figure out what our needs were. We felt included in the process. He asked my daughter about her interests and about her as a person. I liked the clarity and structure of the appointments, the fact that the treatment was integrated into the NHS and not marginal. He kept us informed, writing a detailed report to our GP and copying us in. The follow-up was good. Compared to our experience when we visit the GP where they (under a lot of time pressure) have only a small window to discuss the problem, we felt pleasantly surprised. He had time for us and there was a transparency about the process, which empowered us as patients.”
As these examples illustrate, many patients value compassion, transparency and accountability in their clinicians, prefer to operate from a position of informed choice, and place as much value on the quality of the consultation as on the treatment itself. In addition to offering patient-centred treatment, the nature of holistic medicine is that a significant portion of its evidence base is empirical and anecdotal – rooted in the lived experience of patients and the informed observations of the clinician. We must assess the patient’s recovery in relation to their own optimal health. The patient’s personal story is as valid – if not more so for that individual – as the findings in a clinical trial, and is sometimes the only data available. Indeed, as NHS Choices acknowledges, ‘any medicine or treatment may work differently for different people’. This is a fundamental principal in homeopathy in which the individual’s unique symptom picture and their responses to treatment are paramount as data on which to prescribe. Additionally, as happens in conventional medicine, homeopathic practitioners draw on their clinical training and experience, as well as available research, in their treatment decisions:
“Practitioners of conventional medicine strive to use treatments that are supported by clinical evidence showing they are safe and that they work. Still, the use of treatments in conventional medicine is not always based on scientific evidence. In these cases, use of treatment is based on the clinical experience and training of the health professionals – GPs, nurses, doctors – involved.”
Sadly, homeopathic treatment is often sought after pharmaceutical and other interventions have failed and homeopaths often find themselves picking up the pieces. The use of homeopathy as a frontline treatment would potentially reduce the need for more serious interventions (bypassing, for instance, the adverse effects associated with pharmaceuticals), and (with the emphasis on supporting the patient’s constitution) improve the baseline health of patients. Additionally, a more flexible and integrated approach to patient care would potentially benefit both those patients who want a joined-up health system that addresses all the physical, psychological and emotional aspects of their health in the same consultation and is not forced to compartmentalise them, and the NHS whose financial and time resources are constantly represented in the media as being at breaking point. The Faculty of Homeopathy states that ‘[t]he available evidence suggests that homeopathy has the potential to generate savings through reduced conventional prescribing and demand for other services.
Many of my nursing colleagues support the use of homeopathy in conjunction with conventional treatment – and several of my homeopathy colleagues are also nurses. Support of Clinical Commissioning Groups for integrated homeopathic and conventional medicine, and the willingness of GPs to liaise with and refer patients to local homeopaths warrants further exploration and trial. Clinical and cost outcomes may need to be monitored and assessed by observational studies and other research more suited to patient-centred treatment.
 NHS Lanarkshire Review of Homoeopathy Services – Report on the Public Consultation Exercise (2014) Section 3.1, table 1.
 See http://www.homeopathy-soh.org/research/evidence-base-homeopathy/placebo-effect/ accessed 5.10.14 for a discussion of placebo effect.
 See http://britishhomeopathic.c1055989.myzen.co.uk/wp-content/uploads/2013/05/evidencesummary.pdf accessed 16.9.14 for a summary of the research evidence base for homeopathy.
 Both examples are used with permission.
 See http://www.facultyofhomeopathy.org/research/safety-and-cost-effectiveness/ accessed 5.10.14.
 Clough, M. A Case of Henoch-Schönlein Purpura The Homeopath No. 26:1 2007: 11-13.
 Deng, F. et al. Henoch-Schönlein purpura in childhood: treatment and prognosis. Analysis of 425 cases over a 5-year period. Clin Rheumatol. 2010 April 29(4): 369-74.
 http://www.patient.co.uk/doctor/henoch-schonlein-purpura-pro#ref-10 accessed 5.10.14.
 WHO (2014) ‘Antimicrobial Resistance: Global Report on Surveillance’ available at http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf, accessed 16.9.14.
 http://britishhomeopathic.c1055989.myzen.co.uk/wp-content/uploads/2013/05/evidencesummary.pdf states that ‘[i]ntegration of homeopathy with conventional treatment is associated with better clinical
outcomes for similar or lower costs’, and see http://www.britishhomeopathic.org/safety-and-cost-benefit/ accessed 16.9.14.
 The NHS Choices website presents a negative and discouraging view of homeopathy and CAM, despite the fact that these treatment modalities are offered by the NHS. See http://www.nhs.uk/conditions/homeopathy/Pages/Introduction.aspx accessed 16.9.14.
 A study at Bristol Homeopathic Hospital recorded the outcome of homeopathic treatment in over 6,500 patients with over 23,000 attendances over a 6 year period. At follow-up, 70% of patients reported an improvement in their health, including 50% who reported ‘major improvement’. Spence D.S., Thompson E.A. and Barron S.J. Homeopathic treatment for chronic disease: A 6-Year, university-hospital outpatient observational study. J Altern Complement Med 2005; 5: 793-8; A 500-patient survey at the Royal London Homeopathic Hospital showed that many patients were able to reduce or stop conventional medication following homeopathic treatment. Sharples F., van Haselen R., Fisher P. NHS patients’ perspective on complementary medicine. Complementary Therapies in Medicine, 2003; 11: 243–248.
 E.g. see Roberts, M. ‘Dementia ‘linked’ to common over-the-counter drugs’ available at http://www.bbc.co.uk/news/health-30988643 accessed 27 January 2015; and Marra, F. et al. ‘Antibiotic use in children is associated with increased risk of asthma’. Vol. 123, No. 3 March 1 2009 available at http://pediatrics.aappublications.org/content/123/3/1003.short accessed 5.10.14.
 E.g. homeopathic treatment of ear infections can reduce the use of antibiotics and avert the need for grommet insertion – an observation is based on my clinical experience. See also Frei H., Thurneysen A. Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution? British Homeopathic Journal 2001; 90: 180–2, 2013 revision available at http://static.squarespace.com/static/520f6c38e4b01b013b22f419/t/52bf22a0e4b0410823c26e41/1388257952343/AcuteOtitisMediaBHJ.pdf accessed 5.10.14; Jacobs J., Springer D.A., Crothers D. Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. Pediatr Infect Dis J 2001; 20: 177-83, http://www.ncbi.nlm.nih.gov/pubmed/11224838 accessed 5.10.14; Friese K-H., et al. Homeopathic treatment of otitis media in children: comparisons with conventional therapy. Int J Clin Pharmacol Ther, 1997; 35: 296-301. http://www.ncbi.nlm.nih.gov/pubmed?term=9247843 accessed 5.10.14.
 ‘In France, where homeopathy is an integral part of the healthcare system, a government report showed that the total cost of care per patient receiving homeopathic treatment was 15% less than the cost of treatment provided by conventional physicians.’ http://www.facultyofhomeopathy.org/research/safety-and-cost-effectiveness/ accessed 5.10.14.
© Miryam Clough 2015