Homoeopathy - a sweeter pill?

There's no proof that homoeopathy works. So why is the NHS spending millions on it?

Five years ago, while she was expecting her third child, Nina Barnett started to suffer excruciating lower back pain. It was caused by loosening of the ligaments - a common problem during pregnancy - but Nina, 39, a pharmacist from North London, found that even after she'd given birth to her son, the situation did not improve. "There were episodes of three to four days where I couldn't even hold my baby," she says. "It was so bad that I had to spend some time in a nursing home after the birth and for six months afterwards, I found it hard to get out of bed, walk or go down the stairs.

Five years ago, while she was expecting her third child, Nina Barnett started to suffer excruciating lower back pain. It was caused by loosening of the ligaments - a common problem during pregnancy - but Nina, 39, a pharmacist from North London, found that even after she'd given birth to her son, the situation did not improve. "There were episodes of three to four days where I couldn't even hold my baby," she says. "It was so bad that I had to spend some time in a nursing home after the birth and for six months afterwards, I found it hard to get out of bed, walk or go down the stairs.

"My GP referred me to a physiotherapist, but the pain was still there," she says. "I did pilates, Alexander technique, and of course I sought conventional medical help to deal with the agony - but the only treatments available were very strong painkillers, which I didn't want to take regularly. Painkillers masked the symptoms, but didn't get to the root of the issue. So my GP sent me to the Royal London Homoeopathic Hospital."

Each year some 470,000 Britons spend £25m on homoeopathic remedies, and sales are rising between 15 and 20 per cent annually. And this week, the RLHH, one of five such specialist centres, is moving back to its Queen's Square site after an £18m refit. This coincides with the recently published - and widely publicised - guide to complementary medicine by the Prince of Wales' Foundation for Integrated Health, which has been funded partially the Government. Which raises the question: does homoeopathy work, and does it justify this investment?

Homoeopathy, invented in the 18th century by the German physicist Samuel Hahnemann, is based on the principle that "like cures like", so that pollen, for example, might be used to treat hay fever. Hahnemann used more and more dilute recipes to make his remedies safer, eventually discovering that if he shook his remedies, they would remain effective even when no trace of the original substance remained. It is this idea, that water can "memorise" the imprint of an active ingredient, that is most troubling to scientific minds. A famous French trial in the 1980s appeared to validate the principle, but this has never been replicated since.

Alternative medicine has always had its detractors. "To anyone educated in mainstream science, the mechanisms that are advanced for some complementary medicines seem just bizarre," wrote Andrew Lawson, a consultant at the Royal Berkshire Hospital, recently. But Dr Saul Berkovitz, a consultant at the RLHH, has had as good an education as mainstream science can offer, studying at Cambridge University and Charing Cross Hospital in London.

"During my training, I began to feel there was something lacking in hospital medicine," he says. "When serious disease had been excluded, the drugs were often too strong, like using a sledgehammer to crack a nut. Side-effects of orthodox medication consistently rank amongst the leading causes of hospital admission, ill health and death."

Berkovitz also saw a potential "domino effect". "Say, for example, codeine had been prescribed for arthritis. This can cause constipation, so another drug is prescribed to treat that. Where does it stop? Homoeopathic treatment is a subtle process, like retuning a violin which has gone slightly out of key."

One criticism often levelled at complementary medicine is that it is full of "wackos" giving negligent advice. Much of complementary medicine is unregulated and often mercenary. At the RLHH, however, there is a strong ethic to work hand in hand with orthodox medicine.

First appointments are generally 45 minutes long; follow-ups last 20 minutes. This allows for extensive questioning about lifestyle, diet and stress in addition. "Such details, which may mean little to a conventionally trained doctor, are vital for a tailor-made homoeopathic prescription," says Berkovitz.

Importantly, all the doctors are conventionally trained. "We wouldn't use homoeopathy to treat cancer per se, but it is safe to take alongside cancer drugs, and can reduce side-effects," says Berkovitz. "We have realistic expectations of our treatments. They are not suitable for all ailments: genetic conditions or high blood pressure, for example. Homoeopathy doesn't help everyone."

The conditions it does treat read like a list of general practitioners' "heart-sink" complaints: allergies, headaches, premenstrual syndrome, irritable bowel syndrome, stress, insomnia, back pain. Some have put the high level of referrals to homoeopaths down to GPs' anxiety to rid their consulting rooms of hopeless cases. There may be some truth in this, Berkovitz admits. There is even an acronym, TEETH - "Tried Everything Else - Try Homoeopathy". But this is now much more rarely the case. Many of the RLHH's patients have referred themselves.

At a time when patient choice is at the heart of NHS policy-making, this alone might be seen to justify the millions in public money spent on homoeopathy. Patients are increasingly requesting homoeopathy and other complementary therapies (the RLHH also provides therapies such as herbalism, acupuncture and nutritional medicine).

Up to 40 per cent of GPs are providing access to them, though whether your GP can refer you to a homoeopath is something of a post-code lottery, depending on how local funding is allocated). Surveys show that rates of patient satisfaction with their experience at the RLHH are consistently high and the reduced time these patients spend at their GP's surgery or at specialist clinics makes homoeopathy a cost-effective option.

For now, an important way of judging homoeopathy's effectiveness is perhaps through the anecdotal evidence of patients. Since she first visited the hospital four years ago, Nina Barnett is in good health. She took two homoeopathic pills twice a day until the pain eased, to "tighten the ligaments", a treatment not available in conventional medicine. If the pain comes back, she needs to take them again until it eases, and for two weeks afterwards.

"I'm not saying they waved a magic wand because that didn't happen," she says. "But five years down the line, I'm much better. Since my treatment, I hardly ever need any painkillers, despite cutting back on exercise and having no physiotherapy."

Maybe the effect of "rubbing it better" is more powerful than we realise. "The word 'placebo' means 'I will please', and although it's often used as a criticism of complementary medicine, it can have amazing effects," says Berkovitz. "Otherwise, why would people travel to see us from all over the country? What's more, why would they keep coming back?"

The Royal London Homoeopathic Hospital, despite its name, also offers therapies including acupuncture and Western herbal medicine. Referral by GP is required. 020 7391 8833; www.rlhh.org.uk

Need to know

* Homoeopathy is based on treating "like with like", which means a substance that can cause certain symptoms in a healthy person can cure similar symptoms in a sick person.

* Homoeopathic doctors don't think of illnesses and cures. There is a range of ways of treating each condition.

* A homoeopathic approach aims to address the patient's emotional and spiritual needs.

* Most trials have failed to show a solid scientific basis for homoeopathy. But studies show that most people have a reduction in symptoms and in the need to use orthodox medicines.