HO 45

Memorandum submitted by the National Institute for Health and Clinical Excellence (NICE)

I am writing to provide written evidence in answer to the following questions:

1. Why don't NICE provide guidance/evaluation on homeopathy?

2. Has there ever been an interest in NICE evaluating homeopathy? If so, why was this not approved?

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

NICE produces guidance in three areas of health:

· public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

· health technologies (including technology appraisals) - guidance on the use of new and existing medicines, treatments and procedures within the NHS

· clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

Topics for guidance development are referred to NICE by the Secretary of State for Health, in line with national priorities established for the NHS - for example; policy importance (i.e. whether the topic falls within a government priority area) and whether there is inappropriate variation in practice across the country. Once a topic has been referred, the development of the subsequent advice is entirely the responsibility of NICE.

There are two specific NICE guidance processes relevant here:

· Technology Appraisals - recommendations on the use of new and existing medicines and treatments within the NHS. NICE is asked to look at particular drugs and devices when the availability of the drug or device varies across the country. This may be because of different local prescribing or funding policies, or because there is confusion or uncertainty over its value.

· Clinical guidelines - recommendations by NICE on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

Technology Appraisals

NICE does not produce blanket guidance on the use of 'groups' of therapies, whether complementary and alternative medicines (CAM) or not. To date NICE has not been asked to develop specific guidance on the use of individual complementary therapies. If the Secretary of State for Health referred this topic to us for guidance development, we would develop this guidance. We have not been asked to, and have not turned down a request to evaluate CAM therapies.

Clinical Guidelines

Where the evidence exists, we have considered CAM therapies, including homeopathy, alongside other conventional treatments in a number of our clinical guidelines. NICE has already made recommendations on where complementary therapies do and don't add benefit in relation to specific conditions, including multiple sclerosis, antenatal care, palliative care and most recently, low back pain. A summary of these recommendations is at Appendix 1. Because these guidelines are based on a specific disease or condition, we would not use this process to look at CAM therapies as a whole. We would evaluate, based on available evidence, which specific therapies may be of benefit.

Professor Peter Littlejohns

Clinical and Public Health Director

November 2009

Appendix 1: Summary of NICE clinical guidelines where, based on evidence, NICE has made recommendations on the use of CAM therapies:

Antenatal care:

· Few complementary therapies have been established as being safe and effective during pregnancy.

· The following interventions appear to be effective in reducing morning sickness:

o Ginger

o P6 acupressure

Multiple Sclerosis

· There is some evidence to suggest that the following items might be of benefit, although there is insufficient evidence to give more flexible recommendations

o Reflexology and massage

o Fish oils

o Magnetic field therapy

o Neural therapy

o Massage plus body work

o T'ai chi

o Multi-modal therapy

Dementia

· In the dementia guideline recommendation that for comorbid agitation, interventions tailored to the person's preferences, skills and abilities should be considered. Options to consider include:

o Aromatherapy

o Multisensory stimulation

o Therapeutic use of music and/or dancing

o Animal-assisted therapy

o Massage

Parkinson's disease

· Recommending that the Alexander Technique may be offered to benefit people with Parkinson's disease (PD) by helping them to make lifestyle adjustments that affect both the physical nature of the condition and the person's attitude to having PD.

Supportive and palliative care

· When organising supportive and palliative care services for people with cancer, commissioners and the NHS and voluntary sector providers should work in partnership across a Cancer Network to decide how to best meet the needs of patients for complementary therapies where there is evidence to support their use. As a minimum, high quality information should be made available to patients about complementary therapies and services. Provider organisation should ensure that any practitioner delivering complementary therapies in NHS settings conforms to policies designed to ensure best practice agreed by the Cancer Network.

Hypertension

· Informing people with hypertension that relaxation therapies can reduce blood pressure and individual patients may wish to pursue these as part of their treatment. However, routine provision by primary care teams is not currently recommended. Examples include: stress management, meditation, cognitive therapies, muscle relaxation and biofeedback.

Depression

· Although there is evidence that St John's wort may be of benefit in mild or moderate depression, healthcare professionals should not prescribe or advise its use by patients because of uncertainty about appropriate doses, variation in the nature of preparations and potential serious interactions with other drugs (including oral contraceptives, anticoagualnts and anticonvulsants).

Low back pain

· Consider offering a course of manual therapy, including spinal manipulation, spinal mobilisation and massage. Treatment may be provided by a range of health professionals including chiropractors, osteopaths, manipulative physiotherapists or doctors who have had specialist training

· Consider offering a course of acupuncture needling, up to a maximum of 10 sessions over a period of up to 12 weeks

· Injections of therapeutic substances into the back for non-specific low back pain are not recommended