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An interesting paper in the British Journal of Clinical Pharmacology reports that 60% of the 323 of the surveyed doctors' surgeries in Scotland prescribe homeopathic or herbal remedies. Researchers examined the prescribing data for 1.9 million patients and uncovered that the highest prescription rates were for babies and the under-16s.

• 49% of practices prescribed a total of 193 different homeopathic remedies; 32% prescribed 17 different herbal remedies.
• 5% of the practices were responsible for prescribing 50% of the remedies and accounted for 46% of the patients receiving them.
• 4160 patients (2.2 per 1000 registered patients) were prescribed at least one homeopathic remedy during the study period. 73% were female and the average age of patients was 47.
• Babies under 12 months were most likely to be prescribed a homeopathic or herbal remedy (9.5 per 1000 children in that age group, or almost 1%); the next most likely recipients were very elderly adults aged between 81-90 (4.5 per 1000). 16% of homeopathic prescriptions were for children under 16.
• Fewer patients received a prescription for herbal remedies (361). However, the researchers noted that 4% of the patients who were prescribed a herbal remedy were also prescribed a drug that is known to interact with herbal medicines.

The 5 most commonly prescribed homeopathic remedies were:

• Arnica montana (for injury, bruising)
• Rhus toxicodendron (joint symptoms, headache)
• Cuprum metallicum (cramp, poor circulation
• Pulsatilla (PMT, menopausal symptoms, breast feeding problems)
• Sepia (PMT, menopausal symptoms, fatigue).

The 5 most commonly prescribed herbal remedies were:

• Gentian (poor appetite, digestive problems)
• Cranberry (urinary tract infection)
• Digestodoron (indigestion, heartburn, constipation)
• Evening primrose (PMT)
• Laxadoron (constipation).

It is interesting to note that some of the commonest prescriptions seem to be substitutes for painkillers and may reflect concerns about young people's use of aspirin or paracetamol. Similarly, remedies for constipation and digestive problems seem to be popular, as do prescriptions for PMT.

One of the authors, Dr James McLay commented:

This level of prescribing raises important questions about homeopathic and herbal provision in the UK's National Health Service.

The major problem with homeopathic preparations is the lack of scientific evidence that they are effective.

Given the rise of evidence-based medicine and the trend toward prescribing guidance in the UK, should therapies with no convincing positive clinical trial evidence be prescribed and funded by the health service...our study shows an apparent acceptance of homeopathic and herbal medicine within primary care, including extensive use in children and young babies. We believe that these findings underline the need for a critical review of this prescribing trend.

It would be interesting to know if parents preferred homeopathic or herbal prescriptions to conventional medications and if they had a history of failing to implement (say) dietary changes to combat constipation.

Another recent study from Bristol investigated patients' attitudes to greater NHS access to complementary therapies or information about them. The majority of the interviewees approved of NHS provision of CAM because it would:

• increase patient choice
• improve access by removing financial barriers for patients
• improve patient's self-help.

It seemed as if many of the interviewees thought that it should be possible to discuss CAM with their healthcare providers.

As a minimum, the majority of participants wanted NHS health professionals to be more 'open' towards and know more about complementary therapies than their patients - perceived as not currently usual...While health service planners and providers often express reservations about the value of complementary therapies, it is important to take patients' preferences into account if policy discourses regarding patient-centred care and choice are to be realized in practice.

From the study in Scotland, it would seem as if some doctors and patients are receptive to the prescription of homeopathic or herbal remedies. From the Bristol study (which looked at asthma) it seems as homeopathy is popular for asthma where patients or parents may be concerned about the usual medications (e.g., corticosteroids).

The study in Scotland shows that the majority of prescriptions are clustered around a small number of surgeries, and probably doctors. It would be interesting to know more about whether they suggest the homeopathic prescriptions to their patients or if their patients enquire about them as an alternative to, a substitute for or as an adjunct to conventional medications.

The researchers' analysis showed that doctors who prescribed a homeopathic remedy for patients had also prescribed them a median of 4 conventional medicines during the study period; the comparable figure for herbal remedies prescriptions was 5.
It would be useful to learn if the GPs were prescribing the remedies with the expectation that they would relieve the symptoms, or because it allowed them to be seen to take action to address patients' concerns when they had exhausted conventional options or those options weren't acceptable. However, Dr. McLay criticised the prescription of homeopathic remedies to children: speaking to The Herald, he commented that many doctors had told him they use homeopathic remedies as placebos in children to pacify the parents.

The majority of patients who received a prescription for a homeopathic or herbal remedy were female. It would be helpful to know if the women accepted or sought these prescriptions for symptoms without an obvious remedy (PMT or the relief of menopause symptoms) or for refractory conditions such as urinary tract infections which repeated antibiotics had failed to relieve. Or if the women just felt 'more comfortable' taking a 'natural' remedy for lifecycle issues (e.g., PMT or the menopause).

Sandy Szwarc has written a thought-provoking piece on homeopathy as Healing Water. Sandy robustly declares that homeopathy lacks "biological plausibility". Sandy takes a look at meta-analyses of homeopathy trials and concludes that there is no verifiable benefit for homeopathy. Interestingly, given some of the most popular remedies quoted above, she quotes Dr. Stephen Bratman who says:

There is little doubt that some conditions are quite responsive to placebo treatment, such as menopausal hot flashes, symptoms of prostate enlargement, and many types of pain...While it