Evidence Check 2: Homeopathy - Homeowatch

Evidence Check 2: Homeopathy 13We have heard many conflicting opinions on the idea that high levels of patientsatisfaction could be used as evidence for a therapy's efficacy. It has been argued bysome that such satisfaction is very important […] because much of CAM emphasisespatients’ participation in the therapy and evaluation of its effects. Many otherwitnesses have asserted that although patient satisfaction has its place it is notsufficient to justify accepting that a therapy works so that objective rather thansubjective evidence is needed. The Academy of Medical Sciences explained why thismay be: “It needs to be emphasised that patient satisfaction is not in itself a sufficientestimate of clinical benefit. While it is very important that patients be satisfied withthe efforts made on their behalf, it is at least equally important that they shouldobtain objective benefit. The two do not always go together. For example, patientswith peripheral vascular disease, if they go to a practitioner who allows them tocontinue smoking will show a high patient satisfaction although their outcome willbe poor. In contrast, if they are made to stop smoking they are likely to be dissatisfiedbut their outcome will be much better”. 4543. Another example of how patient satisfaction may not correlate to the medicalintervention might be if a patient seeks treatment for a common cold. The patient’sperception of the quality of the consultation and whether a course of treatment has beenprescribed may contribute to patient satisfaction, irrespective of whether the treatmentitself is effective; the patient would have become better anyway. The House of LordsCommittee concluded:patient satisfaction has its place as part of the evidence base for CAM but its positionis complicated, as Sir Michael Rawlins [Chairman of NICE], explained: “Thedifficulty, of course, is that very often the anecdotal evidence relates to conditionswhere there is fluctuation in the clinical course and people who start an interventionat a time when there is a natural resolution of the disease, very understandably, arelikely to attribute cause and effect when it may not be. But, on the other hand, thereare some anecdotes that are quite clearly important.” Therefore, ideally studiesshould include patient satisfaction as one of a number of measures in evaluating atreatment, but it alone cannot be taken as a proof or otherwise of a treatment'sefficacy or as evidence to justify provision. 4644. We have already outlined that treatments may seem effective irrespective of whetherthey are efficacious. Patient satisfaction therefore, does not help us to distinguish betweenefficacious and placebo treatments; on that basis, it is of less relevance to resolving thisissue than randomised controlled trials, and meta-analyses and systematic reviews ofRCTs. We agree that patient satisfaction may be relevant to the consideration of theeffectiveness of treatments in the real world, rather than efficacy, but its main contributionwould be to identify that research may be needed to establish whether there is a real effect.45 HL Paper (1999–2000) 123, paras 4.21–4.2746 HL Paper (1999–2000) 123, para 4.27