Some more follow-up to the Early Day Motions (EDMs) tabled in the House of Commons by David Tredinnick MP, that I blogged on last week.
Recap: David Tredinnick MP, staunch advocate of homeopathy and sundry “alternative” therapies, tabled four EDMs in parliament earlier this week. One was a motion condemning the British Medical Association’s stance that homeopathy should no longer be funded on the NHS. The other three were motions welcoming scientific “peer-reviewed” papers which at first glance appear to support homeopathy in the treatment of moderate to severe depression, insomnia, and (most worryingly) breast cancer. On closer examination, they do no such thing. Tredinnick was also on the Today Programme on BBC Radio 4 attempting to justify his position and was soundly torn apart by Simon Singh. Tredinnick made so many nonsensical statements that Singh did well to focus his argument on the few main points (given that the debate, such that it is, was being conducted in the public rather than scientific arena). The remainder of the points are dealt with here.
So what now? Firstly, the bad news. Or rather, the deeply depressing news, that Tredinnick (along with fellow ideologue Nadine Dorries) has been elected by the Conservatives to sit on the Select Committee for Health in the House of Parliament. The reasons why the appointment of Tredinnick and Dorries to this committee is regrettable are detailed here. However, the one saving grace, as Martin Robbins points out, is that Dorries has a pretty terrible track record when it comes to attending Select Committees (though of course that comes with the usual “past performance blah blah not indicative blah future results” disclaimer) and Tredinnick’s views are so far out of step with the more sensible members of that committee that they are unlikely to gather any momentum.
And now on to the second, and rather amusing development. Julian Huppert, MP for Cambridge, has tabled some rather extensive amendments to Tredinnick’s EDMs. The original amendments, set out in the formal amendment style (and hence a bit clonky to read), are available here, but since you have to scroll down the page to get to them, I’ve put them here, with the amended bits of the original crossed out.
If the amendments are adopted, EDM 284 would now look like this:
That this House expresses concern at motions 301, 301a, 301b, 301c, 301d, 301e and 301f at this year’s British Medical Association’s (BMA) Annual Representative Meeting, which calls for no further commissioning of, nor funding for, homeopathic remedies in the NHS; believes that the BMA has overstepped its remit by making such statements without proper consultation with its own membership that practice homeopathy and, more importantly, with the tens of thousands of patients who depend on homeopathy; thinks that an integrated NHS, which employs the best from the orthodox and complementary, and which empowers patients, could deliver better and more cost-effective outcomes at a time of financial prudence; and calls on the Government to maintain its policy of allowing decision-making on individual clinical interventions, including homeopathy, to remain in the hands of local NHS service providers and practitioners who are best placed to know their community’s needs. support for the right of the BMA to express its views about the efficacy and cost-effectiveness of any putative health treatment and the appropriateness of the NHS commissioning such treatments; notes that the motions of the 2010 BMA Annual Representative Meeting dealing with homeopathy endorse the findings of the recent report from the Fourth Report of the Science and Technology Select Committee of Session 2009-10 on Evidence Check 2: Homeopathy Fourth Report of Session, HC45, namely that the evidence base is clear that homeopathy is not effective beyond placebo and that scarce NHS funds should not be spent commissioning it at a time when, due to cost, the health service is not able to provide its patients even with treatments that have been shown to be effective in clinical trials; and further welcomes the view of the BMA that healthcare should be based on good evidence of effectiveness and cost-effectiveness.
…and EDM 285, like this:
That this House welcomes the study published in the International Journal of Oncology, 2010 Feb; 36(2): 395-403 which revealed that homeopathic remedies have a beneficial effect on breast cancer cells; notes that researchers at the University of Texas conducted an in vitro study to determine whether products prescribed by a clinic in India have any effect on breast cancer cell lines; further notes that the researchers studied four ultra-diluted remedies, carcinosin, phytolacca, conium and thuja against two human breast adenocarcinoma cell lines, MCF-7 and MDA-MB-231 and a cell line derived from immortalized normal human mammary epithelial cells, HMLE; observes that the remedies exerted preferential cytotoxic effects against the two breast cancer cell lines, causing cell cycle delay/arrest and apoptosis; believes that the findings demonstrate biological activity of these natural products when presented at ultra-diluted doses; and calls for further research in this important area. as an example of the failure of adequate scientific peer review because the paper provides no statistical analysis to support any conclusion, indicates that the experimental control, 87 per cent. alcohol solution, was itself toxic to the cell cultures, does not illustrate or explain the different chromatographic profiles of the solvent and the test substances, and does not provide sufficient data to allow proper evaluation of the study; notes that the lead author has retired and runs a homeopathy website which falsely claims that homeopathy is as effective as a conventional chemotherapy agent, Taxol, in treating breast cancer; further notes that one of the authors, Alison Pawlus, has publicly disowned the paper; regrets that isolated poor-quality studies are cited by proponents of homeopathy to endorse dangerous and exploitative cancer-curing claims in the face of overwhelming weight of scientific evidence against them; and agrees with the conclusions of the Science and Technology Select Committee’s Fourth Report of Session 2009-10, Evidence Check 2: Homeopathy HC45 that putting patients through pointless further clinical trials, and the spending of scarce public sector funds on research into homeopathy cannot be justified.
…and EDM 286 would now read like this:
That this House welcomes the double-blind study conducted at the outpatient clinic at Jundiai Medical School in São Paulo, Brazil, which consisted of patients with moderate to severe depression; notes that patients were randomly assigned to a double-blind treatment with individualised homeopathic Q-potencies or fluoxetine (Prozac); further notes that the non-inferiority analysis indicated that the homeopathic Q-potencies were not inferior as compared to fluoxetine in treatment of this sample; observes that the study is the first randomised controlled double-blind trial with a reasonable number of subjects to draw conclusions about the homeopathic treatment of depression; acknowledges that homeopathy is recognised as a medical specialty in Brazil; and calls on the Government to carry out further research into this area. notes the study published in August 2009 in the journal e-Cam by UC Adler et al, conducted in São Paulo on 91 patients with depression, which claimed that individualised homeopathic treatments were not inferior to fluoxetine, a selective serotonin reuptake inhibitor; further notes that only 55 patients completed the study and that the finding of non-inferiority, while statistically significant, was marginal; further notes that fluoxetine is considered by many to be no more or barely more effective than a placebo in such patients and that this study therefore merely provides further evidence that homeopathy treatment is no more effective than placebo treatment; and supports the findings of the Fourth Report from the Science and Technology Select Committee of Session 2009-10, Evidence Check 2: Homeopathy, HC45, namely that there are ethical problems in prescribing patients placebos without full candour, that the evidence base is clear that homeopathy is not effective beyond placebo and so scarce NHS funds should not be spent commissioning it at a time when, due to cost, the health service is not even able to provide its patients with treatments that have been clearly shown to be effective, and that putting patients through pointless further clinical trials, and the spending of scarce public sector funds on research into homeopathy cannot be justified.
…and the final EDM, number 287, would look like this:
That this House welcomes the randomised, double blind, placebo-controlled study at Durban University of Technology, South Africa, which evaluated the efficacy of homeopathic simillimum in the treatment of chronic primary insomnia; notes that the measurement tools used were a sleep diary (SD) and a sleep impairment index (SII); further notes that the SD data revealed that verum treatment resulted in a significant increase in duration of sleep throughout the study and a significant improvement in SII scores, compared to the placebo treatment which resulted in no significant increase in the duration of sleep; observes that an initial improvement occurred in the placebo group but this was not sustained and that a comparison between the results revealed a statistically significant difference; believes that homeopathic simillimum treatment of primary insomnia is effective compared with placebo in this study; and calls for further research in this area. notes the study conducted at Durban University of Technology, South Africa, by Naude et al, published in Homeopathy (2010) 99 63-68, which claimed that homeopathic treatment of primary insomnia was significantly more effective compared with placebo; further notes that only 33 patients were enrolled, which makes any conclusion statistically questionable, especially given the randomisation did not take account of the distribution of any clinically relevant variables between the resulting two groups, for example any age differences; further notes that there was not full blinding with respect to the dispenser of the treatment; recognises the dangers, inherent with publication bias, in selectively citing isolated small studies of dubious significance in the absence of any demonstration that infinitely diluted and vigorously shaken solutions have a rational and effective method of action; and supports the findings of the Fourth Report from the Science and Technology Select Committee of Session 2009-10, Evidence Check 2: Homeopathy, HC45, namely that there are ethical problems in prescribing patients placebos without full candour, that the evidence base is clearly that homeopathy is not effective beyond placebo and so scarce NHS funds should not be spent commissioning it at a time when, due to cost, the health service is not even able to provide its patients with treatments that have been clearly shown to be effective, and that putting patients through pointless further clinical trials and the spending of scarce public sector funds on research into homeopathy cannot be justified.
My only fear is that if these amendments are passed, they would start to make David Tredinnick, as the original author, look very sensible indeed…