Fish oil and nutraceuticals off the menu in NHS cost-cutting exercise
The plans aim to save the UK’s National Health Service (NHS) €224 million (£200 million) a year in which the governing body’s chief executive described homeopathy as “at best a placebo and a misuse of scarce NHS funds”.
NHS England will cut 18 treatments in total, which include omega-3 fatty acid compounds used to treat high triglyceride levels.
Nutraceuticals glucosamine and chondroitin, used to reduce pain associated with osteoarthritis and lutein and antioxidant supplements such as vitamin A, C E and zinc for use in age related macular degeneration are also to be abolished.
Evidence pointing to omega-3 fatty acid’s beneficial role in cardiovascular conditions and neurological development have been well documented.
However, NHS’ England’s instructions that prescribers not “initiate Omega-3 Fatty Acids for any new patient,” and “deprescribe Omega-3 Fatty acids in all patients,” was down to the National Institute for Health and Care Excellence (NICE) recommendations formed from “a lack of robust evidence of clinical effectiveness or there are significant safety concerns.”
A lack of evidence
The vulnerability of herbal medicines to a cull may be due to how they are approved in the UK.
Under a Traditional Herbal Registration, there is no requirement to prove scientifically that a product works, the registration is based on longstanding use of the product as a traditional medicine.
In addition, the House of Commons Science and Technology Committee identified homeopathic remedy benefits in a 2010 report as not “evidence based” and “any benefits to patients was down to placebo effect.”
Cost to those on low income is a factor also considered by the Royal Pharmaceutical Society (RPS) England board chair Sandra Gidley, who stated that removing homeopathy, which has “no scientific or pharmacological basis,” from NHS supply is long overdue.
Figures noted in the report show that the NHS currently allocates €7 million (£6.3 million) per annum on omega-3 fatty acid compounds, €1.7 million (£1.5 million) on lutein and antioxidant supplements.
The report also noted that €497,598 (£444,535) was used on glucosamine and chondroitin and €111,949 (£100,009) and €103,452 (£92,412) on herbal and homeopathy treatments respectively.
The British Medical Association (BMA) also commented that they could not support recommendations to cut prescriptions for effective medicines.
“Where there are clinical reasons that drugs should not be provided on the NHS, such as for co-proxamol or homeopathic substances, then these should be added to the ‘blacklist’ which formally prevents NHS supply,” said Dr Andrew Green, BMA prescribing subcommittee chair.
“But the suggestion to restrict prescribing of effective drugs that are also available over-the-counter cannot be supported as it is likely to increase health inequalities and expose GPs to the potential for complaints.
“We are particularly concerned about the harm this may cause for those already most disadvantaged in society, and cannot have GPs applying arbitrary means-tests or judgements as to the likelihood of patients not taking recommended medicines on the basis of cost.”
Gidley added that expecting everyone to pay for medicines for common conditions will further increase health inequalities and worsen the health of patients who cannot afford them.
“A blanket ban on prescribing of items available to buy will not improve individual quality of life or health outcomes in England," she said. “Those on low incomes will be disproportionately affected. They should not be denied treatment because of an inability to pay.”