Recently homeopathy has had negative press coverage again. This was triggered by an overview report published by the Australian National Health and Medical Research Council (NHMRC). The report claims that homeopathy is no more effective than a placebo and there is no reliable evidence that it is effective in the treatment of various health conditions. When first reading this conclusion, it sounds like a fatal blow. But what is the truth behind these findings?
Homeopathic institutions worldwide have analysed the results of the NHMRC report. They conclude that the report mainly illustrates the difficulty to assess homeopathic studies and not the ineffectiveness of homeopathy. Homeopathic institutions demand larger, well-monitored studies into homeopathy and money to fund these. They also note that the report does not do justice to the many homeopathic studies which have shown positive results.
The initiative of the Australian National Health and Medical Research Council (NHMRC) to evaluate the evidence base for homeopathy is a positive step. So far, very few nations have attempted an objective and thorough evaluation of homeopathic scientific studies although it is surely needed. But it is at this point where the difficulties begin. What is an objective and accurate way to assess homeopathy? Before we ask this question, we should examine the NHMRC report and the “Information Paper” that is presented to the Australian public. (1)
In Australia, the National Health and Medical Research Council (NHMRC) is responsible for providing advice on matters relating to health and treatment of disease to the public. Its present strategic plan focuses on medical therapies and methods that are not “based on evidence,” such as homeopathy and many other complementary therapies. Being aware that homeopathy is included in numerous publicly funded health care systems and used widely all over the world, NHMRC consequently looked into homeopathy and its effectiveness and safety as a medical therapy. The aim was to provide the outcomes of these reviews to the public, in order “to facilitate decision-making for policy makers and to assist the community in making informed decisions about their health care.” (1)
The results of the homeopathy report “Effectiveness of Homeopathy for Clinical Conditions” will be summarized in an “Information Paper and Position Statement on Homeopathy”. So far, a draft has been released for consultation. Once it is final, the paper will be made available to the wider Australian public. (2)
The objective of the report was “to summarize the evidence from systematic reviews regarding the effectiveness of homeopathy as a treatment for any clinical condition in humans.” (1)
The NHMRC report was drawn up by the research institute OPTUM and assisted by a group of non-homeopathic scientific experts, the so-called Homeopathic Working Group. They chose to focus on systematic reviews of controlled clinical trials of homeopathy in humans instead of individual studies assessing homeopathy. This approach was chosen despite the limitations of the methodology. (1)
The NHMRC claims that the evaluation of the systematic reviews was difficult because of the inclusion of many small or poorly designed studies. Furthermore, the report was based on information within the systematic reviews, which were not of the highest quality. NHMRC also points out that several systematic reviews did not provide specific conclusions relating to each clinical condition included in the review.
Nevertheless, the report’s final conclusion is that “the available evidence is not compelling and fails to demonstrate that homeopathy is an effective treatment for any of the reported clinical conditions in humans.” (1)
The report’s sole focus on systematic reviews is one point that makes the paper questionable. Homeopathy represents an individual medical system with strongly individualized treatments, which make the application of standardized evaluation tools of allopathic, conventional medicine, such as systematic reviews and meta-analyses, difficult or impossible. (3)This has long been known and it is surprising that the Australian council nevertheless chose to focus exclusively on such systematic reviews, thus choosing a type of research methodology that is fairly inappropriate for homeopathy.
As a result of this somewhat improper approach, the systematic review by the NHMRC shows an inadequate picture of the individual studies conducted in homeopathy. By no means do they all show the ineffectiveness of homeopathic treatments as claimed in the report. The Homeopathic Research Institute (HRI) therefore strongly disagrees with the final conclusion in the NHMRC report and points out that for example “the evidence for the effectiveness of homeopathic treatment for Upper Respiratory Tract Infections (URTIs) is reasonably ‘compelling’”. Based on the example of the URTIs-studies they demonstrate the shortcomings of the research method of the report. One of them is the fact that “no consideration has been given to the quality of the homeopathic approach used in the trials”. (4)
Similarly disappointed with the NHMRC report is the Australian Homoeopathic Association (AHA). It also criticizes that “the scientists only focused on one single type of evidence and excluded other evidence types, which are more suited to the way homeopathy is used in clinical practice”. The AHA also calls to attention that the NHMRC working group did not include even one trained and qualified homeopath. (5)
There is general acceptance among the homeopathic scientific community that the report is right in its conclusion that “there is a paucity of good-quality studies of sufficient size that examine the effectiveness of homeopathy as a treatment for any clinical condition in humans”. (1) The majority of homeopathic studies do indeed only involve small numbers of participants. This is mainly due to the high costs involved for large studies. Funding for homeopathic studies is mainly granted by private foundations or the homeopathic industry and is very small compared to conventional medical research. The HRI comments accordingly: “The report only confirms what we already knew – that more high quality research is needed. Until then, the research will remain open to interpretation in some areas and totally inconclusive.” (4)
What remains is the question about the neutrality of those assessing homeopathic studies. Recently Prof. Robert G. Hahn published an article (6) on meta-analyses in homeopathy. His evaluation of the existing studies and systematic reviews showed that homeopathic remedies are often superior to placebo. Hahn made it evident, that a large number of meta-analyses rely on extensive exclusion of homeopathic studies and are guided by a “plausibility bias” dependent on the “belief” of the respective analyst.
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