On the BHA's response

First off, lets take Part 1 - I'm something of a fan of numerical ordering.

They take one paragraph of the report:

1. We recommend that the Government determine the total amount of money spent by the NHS on homeopathy annually over the past 10 years, differentiating homeopathic products, patient referrals and maintenance and refurbishment of homeopathic hospitals, and publish the figures. (Paragraph 15)

and follow this up with

Response: The total spending is of little relevance without an indication of the benefits. We would welcome an analysis of the costs and benefits of the work of the NHS homeopathic hospitals and of GPs who integrate homeopathy in practice. It is important to note, as the Science and Technology Committee has failed to do, that the NHS homeopathic hospitals offer more than homeopathy.

Now it seems to me pretty strange to launch into saying its of little relevance without an indication of the benefits, when a fair chunk of the report (available here) sets out exactly that, or how to do that.

The rest of Part 1 of the response is frankly fairly bland and does nothing in my view to justify any further spending on homeopathy. But read it yourself, and make your own mind up.

As for Part 2, honestly I'm just going to skip that. It's unconvincing to me, and go and read some of Martin Robbins other excellent dissection of the evidence base at layscience.net - such as this piece. He's a man of infinitely more patience than me, when it comes to sorting this stuff out, clearly. Suffice to say I've previously argued why, in the unlikely event there's ever decent evidence for homeopathy it'll have to be so groundbreaking you'll basically read about it in Nature, and unless it gets that recognition I feel entirely justified in dismissing claims on the basis that life is too short to waste trawling through weak evidence from bad studies.

Part 3 is largely similar, but it has a few bits I'd like to highlight.

Here's a bit they quote from the S&TC report:

11. In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos. (Paragraph 70)

and their response

The BHA does not share the committee's conclusions from systematic reviews and meta-analyses.

This is hardly surprising now is it? I mean, it's like if I said "the Earth is round" and the Flat Earth Society issued a statement saying "The FES does not share Mr Edmondson's views". If you did have the opinion that there's zero evidence for homeopathy and that it doesn't do diddly beyond placebo, you'd hardly be a senior member of the BHA would you?

As for

Comprehensive systematic reviews overall are not conclusive either way; the majority have reached the conclusion, qualified by a number of caveats, that homeopathy differs from placebo.

this would be caveats like "because most trials are of low methodological quality and because of the unknown role of publication bias." would it?

Moving on

There is no good reason to accept, as final authority, the views of one opinion leader in homeopathy research such as Professor Ernst over those of his peers, such as Dr Mathie or Dr Peter Fisher.

Well that's true to an extent. If it were a straight run off between Professor Ernst and Dr Fisher you might have to remain undecided, but it isn't a straight run off. You see, Professor Ernst is on the side of probably most doctors and almost certainly most chemists and a significant chunk of the rest of the scientific community. Professor Ernst also takes the view that an implausible thing with no evidence for it is probably wrong. We're not arguing two equal sides - homeopathy is deeply implausible a priori and you can't justify a claim for balance between two opposing views in that situation. One view is just flat out crazy.

The last piece I will pick out from Part 3 is this:

17. We recommend that the Department of Health circulate NHS West Kent's review of the commissioning of homeopathy to those PCTs with homeopathic hospitals within their areas. It should recommend that they also conduct reviews as a matter of urgency, to determine whether spending money on homeopathy is cost effective in the context of competing priorities. (Paragraph 86)

Response:
We find it wholly unacceptable that a parliamentary committee whose remit is science and technology is commenting and making recommendations on local provision of health services.

I find it wholly acceptable - whether a treatment works or not is fundamentally a scientific question. And many medical treatments or diagnostic tools have a basis in technology. To quote the S&TC website "The Committee exists to ensure that Government policy and decision-making are based on good scientific and engineering advice and evidence". That's exactly what they're doing and they're doing a pretty good job, at least in this case.

So, finally, Part 4. This is what caught my eye first, and motivated me to write this.

18. We accept that NICE has a large queue of drugs to evaluate and that it may have greater priorities than evaluating homeopathy. However, we cannot understand why the lack of an evidence base for homeopathy might prevent NICE evaluating it but not prevent the NHS spending money on it. This position is not logical. (Paragraph 90)

Response:
NICE usually reviews the use of specific interventions for particular conditions or groups of conditions, or issues guidelines making treatment recommendations for conditions or groups of conditions. We are not aware that NICE has ever reviewed, for instance, antibiotics or a complementary therapy such as acupuncture, as a whole. It is not clear why the Committee feels it should single out homeopathy in this way. It would be more appropriate for NICE to make recommendations regarding the use of homeopathy - as it has, for instance, for acupuncture in the treatment of low back pain - in the context of condition-specific guidelines. An obvious starting point would be the specific conditions that have been the subject of systematic reviews and meta-analyses of homeopathy.

In the case of back pain, I seem to recall it was as they say, a condition-specific guideline review, so it presumably also covered physiotherapy, chiropractic and other treatments. There's something of an inconsistency perhaps, but not one that troubles me greatly.

Let me suggest, however, why NICE might evaluate certain things before others and might never bother to look at homeopathy. It's actually highlighted by the BHA themselves, although in a rather backward manner, right below. Homeopathy has been around for 200 years. It's never had good evidence to support it when if it were effective it should have been easy to produce it. In contrast, a drug that has just been released generally does have evidence to support it and has been around for a lot less time, and one might have good reason to critically review that evidence (especially when that evidence has come from the people selling it).

Personally I think NICE has plenty to be doing and enough reason to be careful with its budget that it shouldn't touch homeopathy with a 10⁶⁰ foot barge pole.

Next is this cracker:

19. When doctors prescribe placebos, they risk damaging the trust that exists between them and their patients. (Paragraph 97)

Response:
This point is entirely speculative and without any foundation in evidence.

To translate, "Lying is bad. Response: Ahhh but do you have any evidence for that or is it just pure speculation?"
I won't dignify it with any further response.

20. For patient choice to be real choice, patients must be adequately informed to understand the implications of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done, the effectiveness of the placebo--that is, homeopathy--may be diminished. We argue that the provision of homeopathy on the NHS, in effect, diminishes, not increases, informed patient choice. (Paragraph 101)

Response:
The evidence does not support the view that homeopathy is a placebo. It is perverse to claim that preventing patients from accessing homeopathy on the NHS in some way increases their choice.

OK, this is a subtle point, but I think the BHA really should have sat down to think it through. Preventing patients from accessing homeopathy on the NHS does not increase their overall choice. The point is that if you do it, you have to deny patients access to the information that homeopathy does not work and probably equivalently have to deny them access to other information to keep the playing field level (or you get patients asking why homeopathy doesn't come with a big piece of paper covered in small print about possible side effects) and that therefore you reduce their informed choice - not their net choice.

Fundamentally I find their response weak and at times laughable, if healthcare were a laughing matter, which it isn't (the positive and more direct benefits to health from laughter excepted). The S&TC did a great job, and I just hope the government takes on board their recommendations.