A new report from the NHMRC regarding the evidence base for homeopathy raises questions regarding the funding of a range of homeopathic treatments. Many thanks to Loretta Marron, CEO, Friends of Science in Medicine for this overview.
Will homeopathy finally disappear into history? The National Health and Medical Research Council (NHMRC) “concludes that the assessment of the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered”. It’s now official: according to Australia’s peak medical research body, homeopathy doesn’t work!
The homeopathy saga goes back to 2006, when some of Britain’s leading doctors urged their National Health Service (NHS) trusts to stop wasting money on complementary and alternative medicine (CAM) and to pay only for medicine “based on solid evidence”. Homeopathy was singled out as an “implausible treatment for which over a dozen systematic reviews had failed to produce convincing evidence of effectiveness”.
In 2010, the UK House of Commons Science and Technology Select Committee (S&TC) evaluation of this 200-year-old intervention, found that the basis of homeopathy, the principle of ‘like-cures-like’, was theoretically weak and that the concept of “ultra-dilutions can maintain an imprint of substances previously dissolved in them” was scientifically implausible. Their conclusions had been made on the basis of reviews and analyses of randomised control trials (RCTs) of homeopathic interventions.
Even so, the S&TC recommendations were not accepted by the UK Government as their Department of Health response cited the patient’s right to choose their own form of health care. At that time one third of National Health Service (NHS) trusts were paying for homeopathy, spending around £4 million a year on four dedicated homeopathic hospitals and prescriptions. Over the past decade the expenditure has been declining, and one hospital has now closed. In France and Germany, however, the homeopathy industry continues to be worth around €400 million per annum.
In 2011, the Skeptical Inquirer (SI) initiated a citizen petition to the FDA, asking for warning labels to be displayed on homeopathic remedies. The petition also requested that the FDA initiate a rulemaking to require that “all over the counter homeopathic drugs meet the standards of effectiveness applicable to non-homeopathic drugs, and that those not tested for effectiveness carry a warning label”. It took six months for the FDA to respond that they were currently unable to reach a decision on the petition because it raised “complex issues requiring extensive review and analysis by Agency officials”. Homeopathic remedies are exempt from FDA oversight.
The original 2011 NHMRC draft on homeopathy was based on the ST&C recommendations. After it was leaked to the media, it was immediately slammed by our homeopaths who declared that it was biased as it was written by people with vested interests who had repeatedly misrepresented the facts “in an attempt to mislead the public or divert them away from a system of medicine that offers real hope and help – Homeopathy.”
A report for the Swiss Government was cited as proof that homeopathy was both “effective and cost-effective”. This literature review was actually based on four weak and flawed studies over a decade old, producing an evaluation which was “scientifically, logically and ethically flawed“. Only one author was medically qualified, the remainder being homeopaths and CAM practitioners, none of whom declared any conflicts of interest. Even though the Swiss Government had stated that homeopathy did not meet appropriate effectiveness criteria and had decided to remove homeopathy from the State health reimbursement scheme, they backed down following a 2009 referendum, the Government taking the unusual step of giving homeopathy a temporary reprieve, which ends in 2017, unless homeopaths can come up with the necessary standard of evidence to fully meet their reimbursement criteria by 2015.
Our homeopaths also insisted that a new committee be set up which had to include homeopaths, because they were the only ones qualified to assess and comment “in an informed manner” on submitted material. A call was sent out to practising homeopaths and their patients to support them. The NHMRC was forced to publicly backtrack and a Homeopathy Working Committee was set up. This included members trained in homeopathic medicines. At an additional cost of $140,000, they have, for the past two years, evaluated the evidence from hundreds of submissions. They came up with the same conclusion: “there is no reliable evidence that homeopathy is effective”.
There are now over 30 Cochrane reviews debunking homeopathy. Despite the new NHMRC recommendations, the arguments between proponents and opponents will undoubtedly continue; “true believer” vs scientist; anecdotal-based intervention vs evidence-based medicine; case studies vs RCTs.
Will our Government also cry “patient choice” and keep paying rebates to Private Health Insurance (PHI) for homeopathy? Will PHIs drop it from their ‘extras’? Will universities still teach it as a ‘fact’? Will the Balmain Hospital Homeopathy clinic shut down,? Will homeopathic vaccinations disappear? And will pharmacies stop selling these placebos?
Globally, health regulation agencies are heavily influenced by CAM lobbyists with vested financial interests in interventions that lack credible scientific evidence. No other country has had the courage to stand up against their homeopaths – will we be the first?