Australasian Science: Australia's authority on science since 1938

Homeopathy Fails the Test – Again

By Loretta Marron

The National Health and Medical Research Council has found that homeopathy is no better than a placebo. It is one of many such findings around the world, but will it change anything?

Homeopathy doesn’t work. Haven’t we heard that before? Yes! Three years and $140,000 after its first report, the National Health and Medical Research Council (NHMRC) has reconfirmed that “evidence from research in humans does not show that homeopathy is effective”. Australia’s peak medical research body now states officially that homeopathy works no better than a placebo.

Where did this all start? In 2006, some of Britain’s leading doctors urged their National Health Service (NHS) trusts to stop wasting money on complementary and alternative medicine (CAM) and pay only for medicine “based on solid evidence”. Homeopathy was identified as an “implausible treatment” with no “convincing evidence of effectiveness”.

Four years later, the UK House of Commons Science and Technology Select Committee (S&TC) evaluated this 200-year-old intervention, finding its basic premise that “like cures like” was theoretically weak and the concept that “ultra-dilutions can maintain an imprint of substances previously dissolved in them” scientifically implausible. Reviews and analyses of randomised control trials of homeopathic interventions informed these conclusions.

Even so, the S&TC recommendations were not accepted by the UK Government, with the UK Department of Health response citing the patient’s right to choose their own form of health care. At that time one-third of NHS trusts were paying for homeopathy, spending around £4 million per year on four dedicated homeopathic hospitals and prescriptions. Over the past decade the expenditure has declined, and one hospital has now closed.

According to the NHS, there is “no good-quality evidence that homeopathy is effective”. In France and Germany, however, the homeopathy industry continues to be worth around €400 million per annum.

The first NHMRC draft on homeopathy was based on the ST&C recommendations. Australian homeopaths slammed the report, declaring it 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.”

In 2011, the US-based Skeptical Inquirer initiated a citizen petition, requesting that the US Food and Drug Administration (FDA) rule that homeopathic drugs “carry a warning label” as they are not tested for efficacy. It took 6 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 because “they have little or no pharmacologically active ingredients”.

But didn’t a Swiss Government report find that homeopathy was both “effective and cost-effective”? Despite being referred to by homeopaths in many countries as “evidence”, this 2011 literature review was declared “scientifically, logically and ethically flawed” by the Swiss Medical Weekly as it was based on four weak and flawed studies more than a decade old. 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 its health reimbursement scheme, it backed down following a 2009 referendum. It took 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 meet their reimbursement criteria fully by 2015.

Will our government also cry “patient choice” and keep paying rebates to private health insurers for homeopathy? Will insurers drop it from their “extras” policies? 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 Australia be the first?

Loretta Marron is the Chief Executive Officer of Friends of Science in Medicine. A three-time winner of Australian Skeptics’ Skeptic of the Year award, she was a recipient of an Order of Australia Medal “for service to community health” in 2014.

Comments

Marron the Skeptic, but not the scientist

Loretta Marron’s claim, that ‘homeopathy is no better than a placebo’ [1], is based on prejudice, rather than the NHMRC investigation. The NHMRC found that ‘there are no (human) health conditions for which there is reliable evidence that homeopathy is effective’ [2]. The majority of studies were found to be not reliable enough for basing conclusions about whether homeopathy (in the examined protocols) was / was not effective, either because they were too small, failed other quality criteria, or hadn’t been independently repeated, regardless of the statistical significance of the results. Over 40 trials were identified with statistically significant results favoring homeopathy over placebo, with no superior trial of the same protocol contradicting any of those results. In 29 conditions only 1 trial in each was identified, and it was ‘unreliable’. Consequently no conclusion could be drawn. Logically therefore it remains an open question whether homeopathy (as used in these trial protocols) is more effective than placebo, as well as the countless protocols that haven’t been investigated. Similar considerations apply to the 15 conditions in which trials compared homeopathy protocols to other commonly used interventions, rather than placebo. So Loretta misrepresented the NHMRC findings,

Even in the 13 conditions in which the NHMRC claimed that homeopathy was found to be not more effective than placebo, this was a misrepresentation of the facts, because it was based on a false assumption. The fallacy was that a larger or higher quality study using one protocol could negate a positive result using a different protocol, suggesting that all homeopathy protocols are the same. That is like suggesting that a trial result using one antibiotic, would necessarily apply to trials of any antibiotic. The NHMRC also appears to have adopted different trial size and quality criteria to conclude that homeopathy is not more effective than placebo, than were required to accept the opposite. Is that bias? Only in 6 of these 13 conditions is the NHMRC’s conclusion therefore warranted, and therein, only in relation to the protocols used in the examined trials, and not to protocols that haven’t been investigated.

The NHMRC investigation did not involve any new primary research, and largely examined other reviewers’ summaries of the research of 3rd parties. The main emphasis was on the quality of the research, with the result that the NHMRC now understands in more detail the uncertainty about the efficacy of homeopathy. The process assumed that homeopathy didn’t work, and unsuccessfully attempted to find research of sufficient quality to prove that assumption wrong. This did not, however, prove the assumption to be correct, as it only evidenced the lack of high quality research.

Neither the NHMRC nor Loretta mentioned the context of the financial and practical difficulties involved in conducting high quality research, nor the need for research to satisfy external validity criteria before conclusions can be extended to normal practice. The lack of sufficient quality research supporting homeopathy may be more related to the difficulties in conducting large enough high quality trials, than to the lack of efficacy of homeopathy. Considering that this project was intended for the general public, it would have been appropriate for the NHMRC to contextualize their findings with the breadth of medical research, eg as found on the BMJ website [3]. The published research of 3,000 treatments has been evaluated, indicating that 11% are beneficial, 24% likely to be beneficial, 7% as a trade off between benefit and harm, 5% unlikely to be beneficial, 3% likely to be ineffective or harmful, and 50% being of unknown effectiveness after investigation’. I wonder whether Loretta spends as much time and energy proselytizing against each of the 1,950 treatments which are not in the upper two categories, as she does against homeopathy.

Loretta failed to mention any of the limitations of the UK House of Commons Science and Technology Select Committee (CSTC), one of which was that the report was ratified by only 3 of the 14 member committee. 2 of the 3 were not present at the committee meetings (and one of the two was not even a member of the committee when the hearings were held). The third was well known for his predjudice against homeopathy. A 4th member was opposed. and the rest abstained, possibly because of their awareness that it was a political document pretending to be scientifically based.

Loretta’s logic would have you believe that before research is conducted, a therapy cannot be effective, and that somehow it is the research observing the therapy that makes it effective. She is living up to her description as a ‘skeptic’, ie a prejudiced observer who invents conclusions to satisfy her mindset.

1. http://www.australasianscience.com.au/article/issue-june-2014/homeopathy-fails-test-–-again.html
2.https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02_nhmrc_statement_homeopathy.pdf
3. http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisation...

Dr Nick Goodman
Director Sydney Homeopathic Hospital Clinic at Balmain Hospital

Formerly the Professor of

Formerly the Professor of Complementary Medicine at the University of Exeter (the first such academic position in the world), Edzard Ernst was brought up on homeopathic remedies, which were prescribed to him as a child and which he later prescribed to his family and friends. When he worked for the Munich Homeopathic Hospital, he asked his medical director: “What precisely causes the improvement of our patients?”. The director responded: “It’s mostly due to the fact that we discontinue all the useless medications they had been taking previously.” It's in his book "A Scientist in Wonderland - A memoir of searching for truth and finding trouble".

Homeopathy, a belief-based intervention, usually administered with no molecules of the ‘active ingredient’ remaining in the final ‘remedy’, is a form of mythical, "energy medicine" - which, if it worked, would require university courses in physics and chemistry to be re-written.

Complaints about the NHMRC review are dealt with in Ernst's article: http://edzardernst.com/2015/03/15-arguments-for-homeopathy/

Homeopathy is an “implausible treatment” with no “convincing evidence of effectiveness” - based on pseudo-scientific principles and failing when tested. No amount of wishful thinking or ad hominem attacks by its proponents on those who challenge it, can change this simple fact.

Loretta Maron
Friends of Science in Medicine

Further reply to Loretta Maron

None of Edzard’s 15 responses address the point I was making about Loretta’s misrepresentation of the NHMRC’s research and report. Nor do his arguments address the points I made about the inadequacies of the NHMRC investigation. I could expand on the bias inherent in that report, but because it involves considerable detail, I’ll keep that until it is requested. He also may have a problem with misrepresentation, with his suggestion that ‘the panel…included a homeopath’. If he was referring to the HWC, the person he was referring to was a pharmacist who has research experience in complementary medicine, but who (after discussion with her) I am sure would not describe herself as a homeopath.

I can match Loretta’s tangent to Edzard with Shakespeare’s Hamlet’s ‘There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.’ Loretta is concerned that proof of the efficacy of homeopathy ‘would require university courses in physics and chemistry to be re-written.’ Hahnemann would then be in good company eg Copernicus, Galileo, Newton, Mitchell and Laplace, Einstein, Heisenberg, and Hawking to name a few.

The message still hasn’t sunk in to Loretta, as she is holding to the idea that ‘homeopathy is….failing when tested’, despite the fact that the NHMRC’s investigation, the most rigorous ever conducted according to Edzard, concluded that there was insufficient evidence to come to a conclusion concerning the efficacy of homeopathy. It hasn’t failed, it has been insufficiently investigated.

Lorettas also seems concerned about ‘ad hominem attacks’ on herself, ie when it is being pointed out that she is in error, despite the fact that she makes a policy of attacking all the people who study, prescribe, use and are convinced from experience that homeopathy has been effective. Is that hypocrisy?

Dr Nick Goodman

NHMRC and Homeopathy

Dr Goodman's comments in response to Ms Marron appear to be a bit disingenuous. The NHMRC's conclusion is that there is no good quality evidence for efficacy for homeopathy (beyond placebo) for any medical condition.

Certainly many people are "convinced from experience", as Dr Goodman asserts. Equally, many people are "convinced from experience" that astrology works, or that certain people hold clairvoyant talents, or that demonic possession exists. This is due to the human tendency to associate positive events - "I took the remedy and I got better"- therefore it must have been the remedy. Or, "the clarivoyant said that I would marry a much older man, and I did, so she must have foreseen the future".

That's why the scientific method requires appropriate methodology, including placebo controls and blinding. When these studies are done, homeopathic "remedies" show no greater effect than placebo.

The originator of Homeopathy, Samuel Hahnemann, lived at a time when medicinal science was not well-developed - there was no technology to image the cellular organelles or measure the sodium concentration inside cells. We now know in great detail how a huge number of physiological mechanisms function, and that Hahnemann's model is not plausible, much as Hippocrates' humors have also been disproven.

To add to the fund of world knowledge, it's not enough to postulate something different - one must also be correct. Hahnemann was simply wrong.

It takes significant cognitive dissonance to be trained in the clinical sciences and yet promote therapeutic activity for solutions of water and/or alcohol which may contain not a single molecule of the starting substance.

I suspect that practitioners understand that homeopathy is placebo, but enjoy the chance to help people feel better. Is there anything wrong with this? Yes, there are at least two consequent harms. First, it is deceptive, and therefore unethical, and second, it creates a dependence on taking "medicine" when reassurance or other lifestyle changes are more appropriate.

Sue Ieraci

The background of closure of the Sydney Homeopathic Hospital

I Dr Harry F Haber was the chairperson of the Glebe Hospital at the time of the closure in 1989, the area CEO Dr Diane Horvath made the decision to close the hospital without any discussion with the medical board. Despite support to maintain this only GP hospital in Sydney by the then opposition leader Mr Bob Carr. An arrangement was made by a group of doctors who were practicing Homeopathic medicine. They had no connections with the visiting medical officers of the Glebe Hospital. This was done to allow the area health the access to two million dollars which was earmarked to rebuild a new forty bed unit on the site of the Glebe hospital for the community to continue a GP hospital. There still exists some legal matters regarding the terms of the bequest which I believe required the provision of a bed for homeopathic treatment. This was never provided at Balmain Hospital. None of the GP doctors were given visiting rights to Balmain Hospital that were available at the Glebe hospital