Government cares more for Tiddles than for You

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A little while back I published some correspondence with Francis Maude, my MP and now Minister for the Cabinet Office and Paymaster General, discussing the report on homeopathy by the House of Commons Science and Technology Committee. I urged him to back their conclusions and to stop allowing public money to be spent on a treatment that hasn't been shown to work. In his reply he said:

Where a doctor and a patient believe that a homeopathic treatment may be of benefit to the patient, I believe doctors should be free to prescribe that medicine. All therapies should be considered equally, and decisions on whether or not to provide them on the NHS should be evidence-based, as is the case with all other conventional medicines and treatments.

He took the approach that patient choice was an important aspect in the provision of homeopathy. One wonders, if someone requested hoodoo, or sexual healing, would he be so keen to support patient choice? I wrote back to him pointing out this paragraph from the report:

The Government’s position on homeopathy is confused. On the one hand, it accepts that homeopathy is a placebo treatment. This is an evidence-based view. On the other hand, it funds homeopathy on the NHS without taking a view on the ethics of providing placebo treatments. We argue that this undermines the relationship between NHS doctors and their patients, reduces real patient choice and puts patients’ health at risk. The Government should stop allowing the funding of homeopathy on the NHS.

...noting that the Committee's position was that homeopathy reduced patient choice. He replied:

I think this argument you refer to is flawed. The argument goes that patient choice is meaningless when patients are not properly informed about the implications of the treatments they are selecting, and thus diminishes "real" patient choice.

In arguing this, the Select Committee pass judgement on homeopathic treatments, labelling them a "phoney" or "fake" choice. I am not a medical expert, and would not like to make judgements of this kind in the place of experienced medical professionals. GPs rightly should provide information to patients about different treatments, and must be held to account for the decisions they and their patients make under their advisement. I would not seek to undermine this critically important relationship in this way.

It is difficult to see how taking this choice away from GPs and patients could constitute an increase in choice; in my opinion this is simply taking choice away.

Should patients also be supported by the NHS if they choose urine therapy too? Or would that be taking the piss? Of course, the major flaw here is that GPs are in no position to judge the efficacy of any particular treatment either; that is determined by peer-reviewed clinical trials. Despite not being a medical expert himself, and apparently unacquainted with the science, he still sees fit to support public funding of a treatment that hasn't been shown to work. So far, so inconsistent.

But now the government has decided to add another layer of inconsistency on top of this watered down approach. DEFRA have clamped down on the use of homeopathic remedies for animals:

Some herbal and homeopathic products are claiming medicinal benefits without scientific proof, meaning they may not properly treat or prevent serious diseases, leaving pets at risk.

The Veterinary Medicines Directorate’s (VMD) Director of Operations, John FitzGerald, said:

“Some of these products are claiming to be effective and safe when no scientific evidence has been presented to us to show they are.

“Animal owners have a right to know if a product does what it claims. The products claim to treat diseases which can cause serious welfare problems and in some circumstances kill animals if not properly treated. So in some cases owners are giving remedies to their pets which don’t treat the problem.”

Bizarre; so these are the Government's current recommendations:

• Animal owners cannot choose a homeopathic remedy in conjunction with their vet, because no scientific evidence has been presented to show they are effective and safe, but...
• Patients can choose a homeopathic remedy in conjunction with their doctor, even though no scientific evidence has been presented to show they are effective and safe.

The government clearly doesn't care about our welfare as much as our pets'.


And note that they even allow us the freedom of choice to catch malaria; oh, sweet liberty!

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Correspondence with Francis Maude on Homeopathy

Succussion

After the House of Commons Select Committee report on Homeopathy, recommending that the Government stops funding homeopathic treatments, I emailed my MP, Francis Maude, asking him to support its conclusions. He replied by letter:

24th February

Dear Mr Jones

Thank you for your recent e-mail about homeopathy, following the report produced by the House of Commons Select Committee on Science and Technology.

I am aware that there are differing views on the provision of homeopathic remedies, with some arguing that there is not enough evidence to support their availability via the NHS, while others argue that greater access to complementary therapies in the NHS might lead to widespread benefits.

Conservatives believe that the NHS should not rule out providing alternative therapies. Homeopathy and alternative treatments are a valuable resource for doctors to be able to draw upon when offering treatments. Where a doctor and a patient believe that a homeopathic treatment may be of benefit to the patient, I believe doctors should be free to prescribe that medicine. All therapies should be considered equally, and decisions on whether or not to provide them on the NHS should be evidence-based, as is the case with all other conventional medicines and treatments.

Once again, thank you for taking the time to write to me on this issue.

Francis Maude

Noting his liking for patient choice, I quizzed him on the suggestion by the Committee that homeopathy actually *reduced* patient choice (para 101):

Dear Rt Hon Francis Maude,

Thank you for your letter of 24th February.

You say that you want doctors free to prescribe a homeopathic treatment, where the doctor and the patient believe it may be of benefit. But as the Select Committee reported,

"The Government’s position on homeopathy is confused. On the one hand, it accepts that homeopathy is a placebo treatment. This is an evidence-based view. On the other hand, it funds homeopathy on the NHS without taking a view on the ethics of providing placebo treatments. We argue that this undermines the relationship between NHS doctors and their patients, reduces real patient choice and puts patients’ health at risk. The Government should stop allowing the funding of homeopathy on the NHS."

So, you seem to be arguing for patient choice, but the Select Committee think you are in fact arguing for less patient choice. Could you explain why you are right, and the Select Committee wrong?

Perhaps you could also confirm you are happy for this correspondence to be made public; if I don't receive a reply, I'll assume that is the case.

Yours sincerely,

Mark Jones

He replied and said that he disagreed with the committee's argument:

9 March 2010

Dear Mr Jones

Thank you for contacting me again about homeopathy.

I think this argument you refer to is flawed. The argument goes that patient choice is meaningless when patients are not properly informed about the implications of the treatments they are selecting, and thus diminishes "real" patient choice.

In arguing this, the Select Committee pass judgement on homeopathic treatments, labelling them a "phoney" or "fake" choice. I am not a medical expert, and would not like to make judgements of this kind in the place of experienced medical professionals. GPs rightly should provide information to patients about different treatments, and must be held to account for the decisions they and their patients make under their advisement. I would not seek to undermine this critically important relationship in this way.

It is difficult to see how taking this choice away from GPs and patients could constitute an increase in choice; in my opinion this is simply taking choice away.

Once again, thank you for taking the time to contact me.

Francis Maude

These letters are a cause for concern. The first says that Conservatives think that public money can be spent on alternative therapies. Just to be clear what that means; the Tories are happy for public money to be spent on treatments whose efficacy has not been shown. Mr Maude then couches this support for CAM in terms designed to make it look like support for doctor/patient choice. This is irrelevant, I feel. The Tories would surely not back with public money *any* treatment that a doctor and patient feel would help? No, a line has to be drawn; and where should that line be drawn? Between medicines that are shown to be efficacious and those that aren't. That's why CAM treatments should not be publicly funded. Doctor/patient choice is fine, at their own expense.

The second letter suggests that medical professionals decide what treatments should be provided. This is true, of course, but restricted to treatments that have been licensed for use by the MHRA. Doctors are in no position to determine the state of the science on some pretty complex subjects. That is why the MHRA should not allow homeopathic treatment; because the science says it doesn't work better than placebo. The *science* says that homeopathy is a fake choice, not the Select Committee. This is a vital distinction.

So it's clear that he is in favour of homeopathy (and other alternative medicine) on the NHS, but also of evidence-based medicine *only* for the NHS, which is either a contradiction, or he thinks homeopathy *is* evidence-based. In light of that, I emailed again:

Dear Rt Hon Francis Maude,

Many thanks again for taking the time to respond to me in your letter of 24th February (email response is quite all right, incidentally). I'll take that as a 'No', you won't be supporting the Select Committee's conclusions; at least, not whole-heartedly.

I note, however, that you haven't signed David Tredinnick's EDM expressing concern at the Committee's conclusions, so I'm thankful for small mercies. The idea that MPs should allow public money to be spent on treatments that are no better than placebos astonishes me, but we live in a strange world. For Conservatives intent on making savings in public expenditure it seems doubly odd.

Yours sincerely,

Mark Jones

I shall update again if I get a further reply.

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