Article by Paul Stoneman and Patrick Sturgis from the NCRM Hub, University of Southampton. This article also appears in the Winter 2012 issue of the MethodsNews newsletter (opens a .pdf file).
The appropriate place for Complementary and Alternative Medicines (CAM) in modern healthcare continues to emerge as a source of controversy in policy debates.
The issue attracted media attention again recently, following the appointment in 2012 of the new Secretary of State for Health, Jeremy Hunt, who supports the availability of homeopathic cures through the NHS. Due to the high degree of controversy surrounding its use and regulation, a number of studies have been undertaken which seek, in one way or another, to understand why people use these kinds of treatments. Where studies have been based on sample surveys of the general population, attention has focused on measures of reported use over some reference period. Reported use can then be specified as the outcome in a regression analysis, with demographic and attitudinal predictors introduced to enable inferences about the factors associated with CAM uptake. While this approach has resulted in a number of useful insights, it is problematic to assume that people who report having used CAMs in the past necessarily believe them to be efficacious (that is, better than a placebo) now. Conversely, the fact that an individual does not report having used a CAM in the past cannot be taken as indicating that she believes them to be inefficacious. As a consequence, our understanding of the factors which underpin support and opposition to CAM may be distorted through an exclusive focus on reported use. In this research, funded by the Wellcome Trust, we investigated the correspondence between reported use and the perceived efficacy of a particularly prominent and controversial treatment - homeopathy.
Using data from the 2009 Wellcome Trust Monitor, we found that 18% of UK adults report having used homeopathy at some point in the past. However, when asked their reasons for using it, only 16% spontaneously reported it being due to its superior efficacy relative to conventional treatments. The most frequent response (49%) was '(I) didn't think it could do any harm'. Similarly, the responses of homeopathy users to a direct question about the efficacy of homeopathy reveal that, while a majority said they thought it was 'just as' (44%) or 'more effective' (13%) than conventional medicine, a substantial minority (21%) believed it to be 'less effective' and 6% reported it to be 'not effective at all'. A yet more striking degree of variability was evident amongst non-users, with more than a quarter believing homeopathy to be 'just as' or 'more effective' than conventional treatments and 16% stating that the efficacy of homeopathy 'depends on the illness'. Although not a strong endorsement, this certainly cannot be taken as rejection of homeopathy as a potentially effective cure. Combining the views of users and non-users, we find that more than half of UK adults appear to believe homeopathy is as effective or more effective than conventional medicine.
Multivariate analyses revealed that the social profile of the typical homeopathy supporter is quite different, depending on whether support is operationalised as perceived efficacy or reported use. Homeopathy use was most strongly associated with the reporting of specific symptoms, as well as scepticism about conventional medicine. Perceived efficacy, on the other hand, was primarily related to concerns about the pace and governance of medical research.
These findings have both methodological and substantive implications. Methodologically, we show that reported past use is a problematic indicator of an individual's beliefs about treatment efficacy. Substantively it is clear that, when we take into account the high degree of what might be termed 'latent support' for homeopathy amongst the sub-group of non-users, a majority of Britons appear to endorse homeopathic remedies as potentially efficacious treatments.
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A working paper that this newsletter article is based on is available: 'Understanding support for Complementary and Alternative Medicine in general populations: Use and perceived efficacy' and a podcast with Patrick Sturgis talking about the research.
Forthcoming: Stoneman, P. Sturgis, P. and Allum, N. (in press) Understanding Support for Complementary and Alternative Medicine in General Populations: Use and Perceived Efficacy. PLOSone.