Australia’s NHMRC contravenes a breakthrough report from Swiss Government

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In Europe, as well as across more than 50 countries worldwide, homoeopathy is rapidly growing in popularity. In France, for example, almost half of the population uses homoeopathic medicines, and around 40% of French doctors prescribe them. Homoeopathy is practised by trained homoeopaths, doctors, nurses, midwives, heilpraktiker (in Germany), and many other health care providers. According to the World Health Organization report in 2001 (Legal Status of Complementary/Alternative Medicine: A World Review), homoeopathy is part of the national health system in many of these countries. WHO has declared homoeopathy to be the second most used complementary/alternative medicine (CAM) internationally.

CAM (complementary/alternative medicine) includes acupuncture, osteopathy, chiropractic, shiatsu, phytotherapy, anthroposophical medicine, reiki and many other forms of relaxation treatment, reflexology, ayurvedic medicine and TCM (traditional Chinese medicine), and, of course, homoeopathy.

CAM is increasingly being chosen by well-informed patients and health care professionals both here in Australia, as well as overseas, as a complementary or alternative approach to the pharmaceutical and technologically-based intervention of mainstream medicine. It’s such a pity that the powers-that-be here in Australia apparently have a different agenda.

In the following article by Dana Ullman, and based on his Huffington Post column, you will find a very interesting study the Swiss government initiated into the efficacy and cost-effectiveness of homoeopathy.

The Swiss government has a long and widely respected history of neutrality, and therefore, reports from this government on controversial subjects need to be taken more seriously than other reports from countries that are more strongly influenced by present economic and political constituencies. When one considers that two of the top five largest drug companies in the world have their headquarters in Switzerland, one might assume that this country would have a heavy interest in and bias toward conventional medicine…but such assumptions would be wrong.

As of the present time, the Swiss government’s report on homoeopathic medicine represents the most comprehensive evaluation of homoeopathic medicine ever written by a government and was published in book form in English (Bornhoft and Matthiessen, 2011). This breakthrough report affirmed that homoeopathic treatment is both effective and cost-effective and that homoeopathic treatment should be reimbursed by Switzerland’s national health insurance program.

The Swiss government’s inquiry into homoeopathy and complementary and alternative (CAM) treatments resulted from the high demand and widespread use of alternatives to conventional medicine in Switzerland, not only from consumers but physicians as well. Approximately half of the Swiss population have used CAM treatments and value them. Further, about half of Swiss physicians consider CAM treatments to be effective. Perhaps most significantly, 85% of the Swiss population wants CAM therapies to be a part of their country’s health insurance program. It is therefore not surprising that over 50% of the Swiss population surveyed prefer a hospital that provided CAM treatments rather than one that is limited to conventional medical care.

Beginning in 1998, the government of Switzerland decided to have its national health insurance reimburse for health care services that included complementary and alternative medicines, including homoeopathic medicine, traditional Chinese medicine, herbal medicine, anthroposophic medicine, and neural therapy. This reimbursement was provisional while the Swiss government commissioned an extensive study on these treatments to determine if they were effective and cost effective. The provisional reimbursement for these alternative treatments ended in 2005, but as a result of this new study, the Swiss government’s health insurance program once again began to reimburse for homoeopathy and select alternative treatments.

In fact, as a result of a national referendum in which over two-thirds of voters supported the inclusion of homoeopathic and select alternative medicines in Switzerland’s national health care insurance program, the field of complementary and alternative medicine has become a part of this government’s constitution.

Of interest to most of us is that this report found a particularly strong body of evidence in the homoeopathic treatment of upper respiratory tract infections and respiratory allergies, and cited 24 studies out of 29 with a positive result in favour of homoeopathy. Further, six out of seven controlled studies that compared homoeopathic treatment with conventional medical treatment showed that homoeopathy was more effective than conventional medical interventions (the one other trial found homoeopathic treatment to be equivalent to conventional medical treatment). What’s more is that all of these results from homoeopathic treatment came without the side effects common to conventional drug treatment. In evaluating only the randomised placebo controlled trials, 12 out of 16 studies showed a positive result in favour of homoeopathy.

The Swiss government’s report on homoeopathic medicine was considerably more comprehensive than any previous report written to date. Not only did this report carefully and comprehensively review the randomised double-blind and placebo controlled clinical trials testing homoeopathic medicines, but they also evaluated the ‘real world effectiveness’ as well as its safety and cost effectiveness.

Shang – a researcher with dubious scientific methodology

The authors of the Swiss government’s report acknowledged that a part of the overall review of research included one review of clinical research in homoeopathy (Shang, et al, 2005). However, they also noted that this review of research has been widely and harshly criticised by both advocates and non-advocates of homoeopathy. The Swiss report noted that the Shang team did not even adhere to the QUORUM guidelines which are widely recognised standards for scientific reporting. The Shang team initially evaluated 110 homoeopathic clinical trials and then sought to compare them with a matching 110 conventional medical trials. Shang and his team determined that there were 22 ‘high quality’ homoeopathic studies but only nine ‘high quality’ conventional medical studies. Rather than compare these high quality trials (which would have shown a positive result for homoeopathy), the Shang team created criteria to ignore the majority of high quality homoeopathic studies, thereby setting up support for their original hypothesis and bias that homoeopathic medicines may not be effective.

Sackett’s reasoning is a bit off-track too

The Swiss report also notes that David Sackett, MD, the Canadian physician who is widely considered to be one of the leading pioneers in ‘evidence based medicine’, has expressed serious concern and critique about those researchers and physicians who consider randomised and double-blind trials as the ONLY means to determine whether a treatment is effective or not. However, to make this claim, one would have to acknowledge that virtually all surgical procedures were ‘unscientific’ or ‘unproven’ because so few have undergone randomised double-blind trials. Therefore, for a treatment to be determined to be ‘effective’ or ‘scientifically proven’, one must evaluate real world effectiveness which results from a more comprehensive assessment of what does and does not work. Ultimately, the Swiss government’s report on homoeopathy represents an evaluation of homoeopathy that included an assessment of randomised double-blind trials as well as other bodies of evidence, all of which together led the report to determine that homoeopathic medicines are indeed effective.

More scientific details regarding the Swiss government’s ‘Health Technology Assessment’

If you are a professional in the CAM field, you may be interested in the following extra procedural information.

The report also conducted a highly comprehensive review of the wide body of preclinical research (fundamental physio-chemical research, botanical studies, animal studies, and in vitro studies with human cells). And still further, this report evaluated systematic reviews and meta-analyses, outcome studies, and epidemiological research.

This wide review of research carefully evaluated the quality of studies conducted, both in terms of quality in which the studies were designed and performed (called ‘internal validity’) but also in terms of how appropriate the study was for the way that homoeopathy is commonly practiced (called ‘external validity’). The subject of external validity is of special importance because some scientists and physicians have conducted research on homoeopathy despite having little or no understanding of this type of medicine (for instance, some studies tested a homoeopathic medicine that is rarely used for the condition tested). When these select studies inevitably showed that the homoeopathic medicine did not ‘work’, the real and more accurate assessment must be that the studies were set up to disprove homoeopathy… or simply, the study was an exploratory trial that sought to evaluate the results of a new treatment (exploratory trials of this nature are not meant to prove or disprove the system of homoeopathy but only to evaluate that specific treatment for a person with a specific condition).

The Swiss report evaluated pre-clinical basic research and, in evaluating the high quality studies, the report asserted that homoeopathic high potencies induce regulative and specific changes in cells or living organisms. They also evaluated 22 systematic reviews of clinical research testing homoeopathic medicines and found that 20 of these reviews detected at least a trend in favour of homoeopathy.*

* Although this Swiss government report was published in book form in 2011, the report was finalised in 2006. In light of this date, the authors evaluated systematic reviews and meta-analyses on homoeopathic research up until June, 2003.

Dana Ullman has devoted his life to homoeopathy. He regularly speaks at leading medical schools and universities. He has authored ten books and authored chapters on homoeopathy in three leading medical textbooks. He also authors an exceedingly popular column at the HuffingtonPost.

Dana Ullman, MPH Homeopathic Educational Services 812 Camelia St. (NEW address: 11/01/11)? Berkeley, CA. 94710 (510)649-0294  (800)359-9051 (orders only in the U.S.)  (510)649-1955 (fax)

REFERENCES:

Bornhoft, Gudrun, and Matthiessen, Peter F.  Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs.  Goslar, Germany: Springer, 2011.  http://rd.springer.com/book/10.1007/978-3-642-20638-2/page/1

Bornhöft G, Wolf U, von Ammon K, Righetti M, Maxion-Bergemann S, Baumgartner S, Thurneysen AE, Matthiessen PF.  Effectiveness, safety and cost-effectiveness of homeopathy in general practice – summarized health technology assessment. Forschende Komplementärmedizin (2006);13 Suppl 2:19-29.  http://www.ncbi.nlm.nih.gov/pubmed/16883077

Dacey, Jessica. Therapy supporters roll up sleeves after vote. SwissInfo.ch, May 19, 2009. http://www.swissinfo.ch/eng/politics/Therapy_supporters_roll_up_sleeves_after_vote.html?cid=670064

Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analysed trials.  Journal of Clinical Epidemiology. October 2008. doi: 10.1016/j.jclinepi.2008.06/015.  http://www.jclinepi.com/article/S0895-4356(08)00190-X/abstract

Rist L, Schwabl H: Komplementärmedizin im politischen Prozess. Schweizer Bevölkerungstimmt über Verfassungsartikel «Zukunft mit Komplementärmedizin» ab. Forsch Komplementmed 2009, doi 10.1159/000203073.
(Translation:  Complementary medicine in the political process: The Swiss population votes on the Constitutional Article “The future with complementary medicine“
http://www.ayurveda-association.eu/files/swiss_referendum_on_cam_-_forschkomplementmed_2009.pdf

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