09 April 2014

NHMRC Homeopathy paper

The National Health & Medical Research Council has released its draft Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions, characterised as providing "a plain language summary of NHMRC's assessment of the evidence on homeopathy".
The purpose of public consultation is to ensure that that the relevant evidence has been identified and appropriately considered in the development of the draft Paper. NHMRC is also seeking feedback about whether the draft Paper is presented in a manner that can be understood by the Australian community. 
The draft paper is accompanied by
  •  Effectiveness of Homeopathy for Clinical Conditions: Evaluation of the Evidence – Overview Report. This is an independent systematic review of the available systematic reviews (an overview) on the effectiveness of homeopathy in treating a variety of clinical conditions in humans. 
  • Effectiveness of Homeopathy for Clinical Conditions: Evaluation of the Evidence – Review of Submitted Literature. Additional evidence was submitted to NHMRC from homeopathy stakeholder groups and members of the public prior to the commencement of the review. A consideration of evidence‑based guidelines and government reports on the use of homeopathy. 
The 'assessment of evidence' documentation (i.e. Overview Report and Review of Submitted Literature) has "been released for background only, to assist interested parties in considering NHMRC's draft Information Paper. The content of these reports is not subject to consultation."

Consistent with the weight of solid research disregarded by homeopathy true believers (some of whom, of course, are found in law schools), the draft paper reports that -
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. 
There were no health conditions for which there was reliable evidence that homeopathy was effective. No good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than a substance with no effect on the health condition (placebo), or that homeopathy caused health improvements equal to those of another treatment.
  • For some health conditions, homeopathy was found to be not more effective than placebo. 
  • For other health conditions, some studies reported that homeopathy was more effective than placebo, or as effective as another treatment, but those studies were not reliable. 
  • For the remaining health conditions it was not possible to make any conclusion about whether homeopathy was effective or not, because there was not enough evidence.
To be confident that the health benefits of homeopathy that were reported in some studies were not just due to chance or the placebo effect, they would need to be confirmed by other large, well-designed studies.
The paper accordingly states -
NHMRC’s interpretation of the assessment of the evidence on the effectiveness of homeopathy 
In line with NHMRC’s function to “advising the community” under section 7(1)(a) of the National Health and Medical Research Council Act 1992 (Cth) and based on the assessment of the evidence of effectiveness of homeopathy NHMRC believes:
  • There is no reliable evidence that homeopathy is effective for treating health conditions. 
  • People who choose homeopathy instead of proven conventional treatment may put their health at risk if safe and evidence based treatments are rejected or delayed in favour of homeopathic treatment. 
  • Homeopathy should not be used to treat health conditions that are serious, or could become serious. 
  • People who are considering whether to use homeopathy should first get advice from a health professional (e.g. GP, specialist, nurse practitioner or pharmacist). Those who use homeopathy should tell their health professionals, and should keep taking any conventional medicines that they have been prescribed. 
In its initial response the Friends of Science in Medicine (of whom I am a member) has written to the NHMRC chair stating -
Government’s response to your report is now all-important. We have observed in other countries the way governments can “water down” very specific recommendations and in recent years there has been little evidence that governments have the courage to stand up to the vested interests of the “alternative” health industry. Our academic, scientific and clinical leadership must emphasise to government the importance of accepting your report unequivocally and the need to continue to address the penetration of pseudoscience into our health care system. Both health outcomes and sustainable cost effectiveness are at stake. 
Appended are comments issued by executive members of FSM speaking as individuals with different areas of expertise. In so doing we have emphasised the need for those universities that have provided credence to homeopathy to cease doing so immediately and champion an evidence based approach to healthcare. We are calling upon the nation’s pharmacists and the private health insurance industry to play a significant role in supporting your message to the community.
It is indeed regrettable that reputable educational institutions continue to embrace homeopathy (e.g. through an Advanced Diploma in Naturopathy) on the basis of market demand. We would, I think, look askance at an Advance Diploma in Faith Healing or Astral Travel or Witchcraft that purported to be the basis for healthcare rather than mere entertainment. Given the lack of a credible evidence base for homeopathy and the nonsensical nature of theorisation (e.g. extreme dilution and water having a memory) it is ethically problematical, if not contrary to Australian trade practices law, for universities and their affiliates to be promoting homeopathy as having any more credibility than consultation with a ouija board