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ECHAMP PRESS RELEASE
THE LANCET TAKES A POLITICAL POSITION
AGAINST HOMEOPATHY
31st of August 2005
The Lancet, one of the best reputed medico-scientific journals in
the world, foresees (or wishes) in its editorial The end of
homeopathy! For ECHAMP (the European Coalition on Homeopathic and
Anthroposophic Medicinal Products), the central question is: what
made The Lancet come out with such unfounded and one-sided
editorial in the issue of August 27th?
The meta analysis of Aijing Shang and colleagues,
Are the clinical effects of homeopathy placebo effects? Comparative
study of placebo-controlled trials of homeopathy and allopathy,
published in the same edition of The Lancet, cannot be the only
reason for the attack on homeopathy by the author of the editorial.
For ECHAMP, the study itself can hardly be taken seriously because
the authors made a peculiar selection (isolation) out of 110
homeopathy trials and 110 matched conventional medicine trials. The
study says that 19% of the homeopathic studies and only 8% of the
conventional studies were of higher quality. A positive surprise
for homeopathy.
In his comments, also published in the same
edition, JP Vandenbroucke from the Department of Clinical
Epidemiology of the Leiden University says: evidence does not exist
in isolation, meaning that sophisticated application of statistics
might not solve the problem when learning that the final conclusion
of the study was made after isolation of only 8 studies on
homeopathy and 6 studies on allopathy out of the 110 for each of
the two approaches! The parameters for selecting or refusing
studies are not mentioned in the article.
This data dredging, as Vandenbroucke says, could
mean that there are other than scientific reasons behind this
isolation of outcomes. Is The Lancet inspired or influenced by
interest groups acting against homeopathy, especially at this
moment, when an aggressive movement is visible against a draft
report by the WHO on controlled clinical trials in homeopathy? Why
did The Lancet publish in the very same issue a report entitled
Critics slam draft WHO report on homeopathy ?
Suggestions are made that The Lancet has become the
victim of a cleverly launched attack against homeopathy by the
influential “quack buster group” which already heavily attacked the
draft WHO study. Both the Belgian and the Dutch chairmen of their
national "anti quackery organisations" have given
interviews to the Lancet reporter McCarthy. Their criticism appears
overly prominent and to be the instigating source for the attack
against homeopathy, accompanied by an editorial full of the much
cited bias problem and far off the reputation The Lancet has
hitherto gained in medical science.
The evaluation reports of the Swiss PEK(1) program,
funding source of the Shang study, without exception arrived at
positive results regarding the efficacy of homeopathic medicine
based on published systematic reviews and randomised clinical
trials (RCT). However, from the point of view of the authors of the
meta-analysis, no effect beyond that of placebo could be found.
This discrepancy is not quite surprising and due to a selection
effect based on the result of the statistical method (funnel
plot).
These standards (i.e. funnel plot method) are likely to be
misinterpreted, especially in individualised medical treatment
schemes such as in homeopathy. Moreover, neither essential criteria
for selection nor the identity of the reviewed studies are
disclosed which supports suspicion in a strategy behind the
publication. The PEK evaluators themselves state that for
methodological reasons meta-analyses could not be considered
unambiguous.
The Swiss Association on Homeopathy HVS suspects a
political intention behind this cascade of Lancet criticism in
order to back up the decision by the Swiss government to stop
reimbursement for CAM medicine.
Two sentences from the discussion of the Lancet
publication by Shang A et al reveal recognition of the widely known
difficulty in comparing allopathic clinical results with those of
homeopathic trials, and the problem to properly assess bias:
1. Conventional
medicine trials ……were carefully matched to homeopathy trials for
clinical
subject and type of outcome. (An almost impossible task!)
2. Different sources of bias are difficult to disentangle.
But obviously the authors knew about the shaky
terrain they had to work on. They emphasise that they had to deal
with the narrow question of whether homeopathic remedies have
specific effects. And, that practitioners of homeopathy can form
powerful alliances with their patients….which might be empowering
and restorative. For some people, therefore, homeopathy could be
another tool that complements conventional medicine, whereas others
might see it as purposeful and antiscientific deception of
patient.
ECHAMP fully agrees with one of the finalising
sentences of the study that clearly, rather than doing
placebo-controlled trials of homeopathy, future research efforts
should focus on the nature of context effects and on the place of
homeopathy in health-care systems.
Stefan Willich, director of the Department of
Social Medicine, Epidemiology and Health Economics at Charité
University Medical Center, Berlin: There is an urgent need for
controlled outcome studies assessing long-term effectiveness of
patients treated with conventional versus complementary medicine.
Apart from medication, the patient preferences and expectations,
therapeutic setting, specific patient/physician relationship need
to be considered and may contribute significantly to overall
treatment effects.
Remains the question, why the Lancet had to take
such a polemic unscientific point of view in its editorial as it
did. Maybe the author himself should have thought a little more
about the deeper meaning of his citation of Kant, namely that we
see things not as they are but as we are.
If you need further information please
contact:
Nand De Herdt, General Secretary (eu.deherdt@wanadoo.fr)
Max Daege, President of ECHAMP (eu.daege@web.de)
ECHAMP E.E.I.G.
Avenue Livingstone 33 - B - 1000 Brussels
Tel.: 0032 (0)2 235 09 81 - Fax: 0032 (0)2 235 09 82
office@echamp.be - www.echamp.org
(1) Complementary Medicine Evaluation Program
(Programm Evaluation der Komplementärmedizin) of the Swiss Federal
Office of Public Health
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