Homeopathy: what the evidence shows and the NHS position

The NHS describes homeopathy as the use of very watered-down mixtures made from plants, animals or minerals to try to treat symptoms. It sits among herbal medicines and complementary therapies, which the NHS defines as treatments that are not part of standard medicine. NHS England's guidance adds that homeopathy seeks to treat patients with highly diluted substances that are administered orally.

The Specialist Pharmacy Service (SPS) review describes the two ideas central to homeopathy: that like cures like, so that a substance which in conventional doses could cause an effect is used in very dilute amounts to treat that symptom; and that the more dilute a preparation is, the more potent it becomes. The preparations are made by repeated dilution and shaking. The SPS notes that the principles on which homeopathy is based are very different to conventional medical beliefs.

The SPS evidence brief was prepared for NHS England. It summarises a 2015 systematic review by the Australian National Health and Medical Research Council, which looked at 57 systematic reviews covering 68 clinical conditions. That review concluded there was no condition for which there was a high level of confidence in the evidence, that the available evidence was not compelling, and that it failed to demonstrate that homeopathy is effective for any of the conditions reported.

The SPS then searched for later systematic reviews and found a further group, which did not change the conclusion because the quality of the trials within most of them was variable. For example, one meta-analysis of individualised homeopathy found a statistical benefit but the authors reported that 29 of the 32 trials had unclear or high risk of bias and that the finding should be interpreted with caution.

The SPS adds that it had not identified any NICE guidance which recommends homeopathy for any clinical condition, and that NICE specifically recommends against its use for otitis media with effusion, induction of labour or lower urinary tract symptoms in men. It also quotes the UK House of Commons Science and Technology Committee, which in 2010 concluded that homeopathic products perform no better than placebos, and notes the government response that local NHS bodies and clinicians are best placed to decide on treatments for their patients.

NHS England's policy guidance on items which should not routinely be prescribed in primary care includes homeopathy. It lists the recommendation as do not initiate, and deprescribe in patients currently prescribed it, with no named exceptions, and it places homeopathy in the category of items of low clinical effectiveness where there is a lack of robust evidence of clinical effectiveness or significant safety concerns. The guidance explains that it commissioned the SPS review because of the range of submissions received on homeopathy.

The NHS patient page on herbal medicines and complementary therapies says the NHS may offer some complementary therapies based on evidence of how well they work and whether they are good value for money, and lists acupuncture for long-term pain, migraine-type headaches or severe hiccups, Alexander technique lessons for people with Parkinson's disease who have balance problems, and hypnotherapy for irritable bowel syndrome that has not responded to treatment. Homeopathy is not among them.

A key risk is what a person gives up or delays by relying on it. The SPS brief quotes the Australian council's view that homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious, and that people who choose it may put their health at risk if they reject or delay treatments for which there is good evidence. It advises getting advice from a registered health practitioner first, telling your health practitioner you use homeopathy, and continuing prescribed treatments.

The NHS advises telling any doctor or healthcare professional treating you if you are using a complementary therapy, not stopping prescribed medicines without talking to your doctor, and asking a GP for advice about symptoms that do not go away or keep coming back rather than relying only on a therapist. It also says that other complementary therapists and herbal medicine practitioners do not need to be registered by law, so before choosing a private therapist you should check that they are registered with a professional organisation accredited by the Professional Standards Authority.

• Do not use homeopathy in place of vaccination, antibiotics, insulin, cancer treatment or other proven care.

• Tell your GP and pharmacist about anything you take, including remedies.

• Seek urgent care for red-flag symptoms exactly as you would otherwise.

• Be cautious about claims to treat serious illness, and about products bought online.

Many people use homeopathy for self-limiting problems such as colds, minor skin complaints or sleep difficulty, or for long-term conditions where conventional treatment has not fully helped. Consultations are often long and attentive, which people value, and symptoms of many conditions rise and fall naturally so improvement can be credited to the remedy. The SPS review describes individualised homeopathy as typically involving a long interview between practitioner and patient.

If you want to try a therapy anyway, it is reasonable to treat it as an addition, never a replacement, and to stop if your symptoms worsen.

Because NHS England advises against prescribing homeopathy in primary care, people who wish to use it generally pay for it privately. Over-the-counter products are sold in pharmacies and online, but a licence or registration for a homeopathic product is not the same as a finding that it works for any condition.