Official Support for Homeopathy Persists

One thing leads to another, and with each step I am angrier. It started with a Twitter tip-off about a video on Facebook recommending homeopathy for coronavirus symptoms. Of course, homeopathic remedies are prescribed totally on the basis of symptoms, as homeopaths have no way of knowing any better, so nothing remarkable about that as such. But the video was made by Dr Elizabeth Thompson, a registered medical doctor, and apparently a consultant at University Hospitals Bristol NHS Foundation Trust. I am not on Facebook and have no desire to be, and the video may have gone now. But it popped up at the same time at the National Centre for Integrative Medicine. At this point I need to explain a bit of history.

Homeopathy in Bristol

There was once a Bristol Homeopathic Hospital. In 2015 the local commissioning group decided not to refer any more patients for homeopathy. Homeopathic services in the Bristol area were relocated to the Portland Centre for Integrative Medicine, described as “a new independent social enterprise”. The Portland Centre has now been renamed the National Centre for Integrative Medicine, and this is where the video at issue is still being hosted.

The excellent Advertising Standards Authority has been pretty quick off the mark regarding what it sees as scams related to the coronavirus pandemic. They have set up a quick reporting form for complaints about misleading health claims related to Covid-19. So I shot off a complaint about this on 13th April. I got a response a week later – impressive. Here is the key part of what they said:

Having now reviewed the ad in light of your concerns, we have come to the conclusion that it was likely to have broken the advertising rules that we administer. I am writing to let you know that we have taken steps to address this. We have explained your concerns to the advertiser and provided guidance to them on the areas that require attention, together with advice on how to ensure that their advertising complies with the Codes.

The General Medical Council’s Standards

Needless to say, here we are nearly three months later and the video is still there. At about the same time I complained to the General Medical Council, on the basis that Dr Thompson had breached the terms of her registration. I cited clause 16b of the GMC’s Good Medical Practice, which states that doctors must:

provide effective treatments based on the best available evidence (my bold)

To summarise a long exchange, the GMC of course refuses to do anything, even when I asked for an internal review. Their defence is that there is no evidence that the doctor has failed to provide effective treatment, even though she might add homeopathy to it. Basically doctors are allowed to prescribe ineffective treatments, as long as they mask that by using effective ones. Astoundingly, the GMC said that the doctor was “entitled to hold an opinion”, and that the effectiveness of homeopathy was a subjective matter. The underlying truth is that the GMC does not want to open this can of worms, with some medical doctors using homeopathy and being members of the Faculty of Homeopathy. But I’ll come back to that.

Refusal to Review

I asked the GMC for an internal review of their decision, which they refused to do. There are two grounds for a review, firstly that there was a material flaw in the original decision, and secondly that new information has been provided. I felt that both criteria were met. It was a matter of record that (a) Dr Thompson recommends and uses homeopathic treatments, and (b) that there is no robust evidence that these treatments are effective. The new information was that the ASA had upheld my complaint and advised Dr Thompson to remove the claims, and that she had ignored that advice. The GMC considered that, as Dr Thompson did not recommend homeopathy in place of orthodox medicine, she still met the standard of clause 16b, so the decision was not flawed. They said that the information about the ASA was not new as I had mentioned it before. It depends on what you mean by `new’. I didn’t mention it in the original complaint because the ASA had not responded then, and I only raised it after the first response from the GMC, in which my complaint was dismissed. So it was new at that stage. The GMC seems keen to nail this one as they also said that:

Although Mr Rose has stated that Dr Thompson has ignored the advice provided by the ASA, we do not have any information to date to suggest this is the case.

I think they do. The ASA’s advice was that the claims on the website were non-compliant with the CAP code, and the claims are as I write unchanged, which I take as ignoring the advice.

Meanwhile, back in Bristol…

All this led me to dig a bit deeper into Dr Thompson’s background. According to their website she was employed by University Hospitals Bristol NHS Foundation Trust as a consultant homeopathic physician. She had an honorary (ie unpaid) post as Senior Lecturer in Palliative Medicine. So her main employment was as a homeopath in the NHS. This despite public statements by the NHS chief executive that “homeopathic remedies were not scientifically validated”. I use the past tense because, after a long struggle, I got the Trust to respond and say that this page was five years out of date. In 2015 all homeopathy services were stopped, and Dr Thompson move to the Portland Centre for Integrative Medicine, now renamed the National Centre for Integrative Medicine (pretentious title as it’s just a private clinic).

…and Oxford

Dr Thompson’s page on the Trust website said that her DM thesis is “the first homeopathic thesis to sit in the Bodleian library describing her research into the use of homeopathy for the cancer patient”. I would love to know what induced the University of Oxford to grant a doctorate in outright quackery, but try as I might I can’t locate the thesis. It hasn’t been put online and I would have to travel to Oxford to read it in the Radcliffe Library. I saw also that at the bottom of the page against “Web links to any published articles” there were only links to the charity Homeopathy UK.

Doctorate research should normally be published, so I had a look at Dr Thompson’s research record on PubMed. For clinical trials there are only two citations, both on homeopathy. One is not a trial but a protocol, and the other is a pilot study with negative findings. This confirms that her primary professional interest is homeopathy – no clinical research publications on palliative care, for which she is a teacher. There were no papers on the subject of her thesis. This is not a doctor who has achieved seniority in real medicine and dabbles occasionally in homeopathy, she is primarily a homeopath.

Who can revalidate doctors?

But back to the Faculty of Homeopathy.During a phone call to the GMC, in passing I asked why they were endorsing homeopathy by appointing the Faculty as a revalidation body. They said that they don’t, they only keep a list of designated bodies, and that these are appointed by the Department of Health. This does not stop the Faculty from stating that it is “the only homeopathic organisation to be recognised by professional bodies such as the General Medical Council”. It is only `recognised’ in that they are on a list derived from the Department of Health and republished by the GMC.

Since 2013 all UK doctors have been subject to revalidation every five years. The GMC has a handy little video that explains the process. Note that the very first requirement they cite is that “you are keeping your knowledge up to date”. Any doctor should know that the totality of evidence shows that homeopathy does not work, so any doctor prescribing it is not up to date and must fail revalidation. But the Faculty of Homeopathy of course has its own responsible officer, who will not fail any member’s revalidation because of that. Both the GMC and the DoH are OK with that. The GMC says that evidence for treatments is not their problem, that’s for others such as NICE and NHS. Of course the others will say it’s not theirs either. It’s never anyone’s problem is it?

Separately, the GMC has said that “doctors must act with honesty and integrity”. Of course they must. Is it honest to prescribe or recommend a treatment that rigorous science says will have no effect? But if the doctor believes in it, they are deluded and not misled say the apologists. Sorry but I don’t buy that. There really is no excuse in 2020 to conclude anything other than that homeopathy is based on a fantasy, and doesn’t work according to the evidence. A doctor who concludes otherwise is not being honest with themselves.

Special Treatment for the Faculty of Homeopathy?

After some difficulty, I made contact with the NHS England regional validation team for London, where the Faculty of Homeopathy is based. I wanted to know how it became a designated body for doctor revalidation. I learned that in 2013 the relevant legislation was amended specifically to include the Faculty. You can see it here. That this amendment was made is interesting, as paragraph 25 of the schedule to the 2010 law only mentions “Any organisation engaged in the provision of treatment for disease, disorder or injury by or under the supervision of a medical practitioner” as a designated body. So why did the amendment add the following?

25A. Any organisation engaged in providing the services of medical practitioners to work as resident medical officers in independent hospitals.

25B. Any organisation engaged in providing medical defence services to medical practitioners in respect of claims for medical negligence or professional misconduct.

25C. Ambulance Trusts.

25D. The British College of Aesthetic Medicine.

25E. The Faculty of Homeopathy.

Could it be because these organisations might not be “engaged in the provision of treatment for disease, disorder or injury”? In general aesthetic medicine would be regarded as cosmetic, so not necessarily treating anything, but is this a tacit admission that homeopathy isn’t either? Anyway, I have submitted a Freedom of Information request to the Department of Health to uncover how and why this amendment was enacted. So if you want to find out, subscribe.

“We won’t review the decision, yes we might, no we won’t”.

The GMC story meanwhile rattled on. A different department, the Fitness to Practise Directorate, took up the challenge and asked for further details of the ASA decision. They indicated that the GMC decision might be reviewed if it could be shown that Dr Thompson had ignored the ASA advice. I duly obtained such details and sent them on to the GMC, who replied predictably:

After careful consideration of the issues raised we have decided not to take any formal action at this stage.

It is noted that the ASA are awaiting our Decision before considering their own action against the doctor. As the doctor is primarily in breach of ASA guidelines, this would be a matter for them to investigate in the first instance.

If their investigations find concerns about the doctor that requires (sic) our consideration they can refer her to us in line with agreed procedures.

They have given up providing a reason for inaction, but I am intrigued by these “agreed procedures”. I have asked both organisations what they are.

Something rotten in the state of doctor regulation

For homeopaths and others who make false claims about health and disease, official recognition is vital. They can’t rely on scientific evidence. So presenting a prominent homeopath as a top consultant in the NHS is important to them. It’s careless of the NHS Trust to leave a misleading page up on their website for five years, but they at least took action very quickly once I pointed it out. The same applies to `recognition’ by regulators. While most forms of quackery have some sort of voluntary regulation, none of it is any more than window-dressing, as evidence of effectiveness is always ignored. But the GMC is another matter, and getting endorsement from that body must have seemed liked manna from heaven.

A note on confidentiality

My blog posts are always published on the basis of public interest, irrespective of confidentiality statements. A public body must expect to be held to account by the public.

Update 14th July 2020

Just heard from Dept of Health. The amendment legislation is coming up for review. This will decide if designated bodies need to be added or removed. It will go out to consultation, so anyone interested should make sure they are on the mailing list.