The recent NHMRC’s review into the effectiveness of homeopathy raises more questions than it answers.
Globally speaking, homeopathy is very popular. As the world’s second-largest system of medicine, and is used by more than two hundred million people. India alone has two hundred thousand practitioners. In both India and Switzerland, homeopathy enjoys the same status as conventional medicine.
In Australia, its position is very different. It suffers from a poor reputation following a negative review that was released in 2015 by the National Health and Medical Research Council (NHMRC). This body has an important role as the government’s medical research organisation, one that gives it substantial power and authority.
A negative label for homeopathy
Following a year-long process, the NHMRC’s review eventually reached a negative conclusion, stating that “…there are no health conditions for which there is reliable evidence that homeopathy is effective.” This was in turn, exaggerated by the mainstream media. It referred to homeopathy as being ‘ineffective’ or even ‘useless’, a mantra that has been periodically repeated by news outlets over the past three years. In addition to damaging the homeopathy sector in Australia, the NHMRC review has to a lesser extent, undermined confidence in it overseas.
Last year, a government report recommended the removal of homeopathic products from pharmacy shelves, a step that would have seriously undermined the industry, and which was later not pursued. A review of homeopathy regulation by the Therapeutic Goods Administration (TGA) favours a low-regulation path where homeopathic medicines are treated as non-therapeutic goods. This would undermine quality control, encourage vexatious complaints, and hand over regulation to the non-medically-oriented Australian Competition and Consumer Commission (ACCC.) Along with nearly all natural therapies, homeopathy is on-track to have its private health rebates discontinued in 2019.
A closer look at the NHMRC review found a range of issues. These include:
- No expert opinion from the homeopathy sector, in violation of the NHMRC’s own guidelines.
- Only systematic reviews being considered.
- Selection criteria that excluded reviews outside of a 16-year time window, and those that had been published in a language other than English.
- An arbitrary minimum of 150 participants was applied in order to qualify. No study published before or since has ever applied such a threshold. The NHMRC regularly conducts reviews with less than 150 participants.
- Such rigorous narrowing-down that of 176 systematic reviews, 171 were rejected, leaving only 5 that were used as the basis for making the evaluation.
- Stringent criteria, requiring the highest level of scientific evidence for systematic reviews (five out of five on what is known as the Jadad scale.)
- Close analysis of the final NHMRC report revealed that that for five health conditions there was reliable evidence of effective treatment (diarrhoea in children, sinusitis, allergic rhinitis, urinary tract infections and lower back pain.) This was however omitted from the conclusions.
The anti-naturopathy lobby group
Other concerns included links between the NHMRC and the anti-naturopathy lobby group Friends of Science in Medicine (FSM), which could be seen as a conflict of interest. Professor Peter Brooks, who was appointed to the expert committee, was chairman of FSM at the time. After the link was exposed, he resigned his chairmanship, but remained on the committee. A further issue is the NHMRC’s bias against homeopathy before the review commenced; in an April 2011 leak the modality was described in a draft position statement as “unethical”, “inefficacious” and “deceptive.”
This was not all. As a result of Freedom of Information (FoI) requests lodged by the Australian Homoeopathic Association, more far-reaching questions arose. In what appeared to be a case of moving goalposts, significant changes were made to research protocol months into the review, most importantly the introduction of the 150 sample size.
Even more remarkably, these FoI requests uncovered that the published NHMRC review was a second attempt. An earlier review had been carried out and completed in 2012 under the name of A Systematic Review of the Evidence on the Effectiveness of Homeopathy. This was started by the author of the NHMRC’s own guidelines on how to conduct evidence reviews. Communication from Professor Fred Mendelsohn on the NHMRC Expert Committee said in part, “I am impressed by the rigour, thoroughness and systematic approach given to this evaluation…….Overall, a lot of excellent work has gone into this review and the results are presented in a systematic, unbiased and convincing manner.”
Hiding the facts
In the light of this glowing evaluation, it is curious that the NHMRC’s stated reason for rejecting it was because it was “poor quality”. As the contents of the first review have never been disclosed, there has been some speculation that it may have evaluated homeopathy positively, which in turn may have resulted in a second attempt in order to achieve a pre-desired negative outcome.
Despite repeated FoI requests, the NHMRC has declined to make this first report public. In order to raise awareness and press for disclosure, the Release the First Report campaign was recently launched by Australia’s homeopathy community. If the first report were to be made available, the methodologies employed in both reviews could be analysed and compared, and an objective conclusion reached.
Meanwhile, a complaint from Complementary Medicines Australia, the Australian Homoeopathic Association and the Australian Traditional Medicine Society has been sent to the Commonwealth Ombudsman, and is currently under review.
Much of the controversy around homeopathy, especially from a mainstream medical standpoint, is founded on the widespread belief that beyond a certain level of dilution, no molecule of the original substance is likely remain in the remedy. If this were the case, it would seem to preclude a physical curative mechanism. However, this notion was upended a few years ago, with work by Professor Jayesh Bellare in India who detected metal nanoparticles in very high homeopathic dilutions of 30C and 200C. It shows that there is more scope for scientific research into this modality, and into possible healing mechanisms.
Release the First Report – www.releasethefirstreport.com
Australia Homoeopathic Association criticisms of the NHMRC review – www.nhmrchomeopathy.com
How Dare They! health fund rebate campaign – www.howdarethey.com.au
Your Health Your Choice petition – www.yourhealthyourchoice.com.au
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