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Swiss Govt Report supports Homeopathy

Press Release

Swiss Federal Government report supports Homeopathy claims

The English translation of the Swiss Health Technology Assessment (HTA) report on homeopathy was published in December 2011. This extensive and authoritative report offers an unambiguous endorsement of the evidence base for homeopathy.

The report also provides strong evidence for the effectiveness of homeopathy in upper respiratory tract infections and allergic reactions (URTI/A).

Executive Summary
The 2006 HTA report on homeopathy was commissioned by the Federal Social Insurance Office (FSIO) as part of the ‘Complementary Medicine Evaluation Programme’ (PEK) which was set up following a decision by the Swiss government in 1998 to ‘provisionally’ include complementary medical disciplines
in the list of services covered by the national statutory health insurance scheme. It was written by a team of German speaking academics and edited by Doctor Gudrun Bornhöft and Professor Peter Matthiessen of the Witten/Herdecke University in Germany.

The authors conclude the report with, “In summary, it can be said that there is sufficient evidence for the preclinical effectiveness and the clinical efficacy of homeopathy and for its safety and economy compared with conventional treatment.”



The objectives of the HTA report on homeopathy were to review:
• publications in the field
• the situation regarding provision of and demand for homeopathy in Switzerland
• the current state of (preclinical and clinical) research
• the effectiveness of homeopathy
• the appropriateness, safety and cost effectiveness of homeopathy.
The HTA methodology is widely used by governmental agencies around the world and is monitored by the non-profit umbrella organisation INAHTA (International Network of Agencies for
Health Technology Assessment). The HTA methodology is a cornerstone of the UK’s NIHR (National Institute of Health Research) strategy for assessing real-world effectiveness, safety and costeffectiveness of therapeutic interventions for the UK’s National Health Service (NHS).

Historical context
To put this report into historical context, in July 1998 the Swiss federal government decided to include the five most widely used complementary and alternative medicines (CAMs) into
the list of medicines covered by the Swiss statutory health insurance scheme (KLV). This was to be continued until June 2005, during which period an evaluation was to be carried out.
The positive findings of this evaluation (published in the form of the HTA report) prompted support for CAM from the evaluation committee and their recommendation that these therapies
continue to be covered by the KLV scheme. The authors quote Walach and Heusser in an editorial of the Forschende Komplementärmedizin, “Under pressure from the authorities, this recommendation was removed from the final report and in June 2005 Federal Counsellor Pascal Couchepin excluded CAM
practised by physicians from the statutory national insurance scheme.” Once this state of affairs became public knowledge, it triggered a national outcry resulting in the call for a referendum.
In this referendum, held in 2009, 67% of the Swiss population voted in favour of homeopathy and other CAMs being included in the national health insurance scheme. Earlier this year, the
Swiss government passed legislation to enact the referendum’s conclusion.

Comparison between the Swiss HTA report and UK ‘Evidence Check 2’ report
For context, it is useful to compare the Swiss HTA report on homeopathy with the UK’s Science and Technology Select Committee Evidence Check on homeopathy carried out in the UK. Similarly, this ‘Evidence Check 2’ report was designed to inform the decision as to whether homeopathy should continue to be offered as part of the UK’s National Health Service. Thefindings of these proceedings, published in February 2010, have received a great deal of attention and been widely quoted, yet
the report was not prepared by experts in the field; the Select Committee report was compiled over a three month period by three MPs with no training in appropriate methodologies, whereas it took seven years for the various parts of the HTAstudy to be undertaken by qualified experts and compiled into
this extensive 234-page report.

Walach and Heusser in an editorial of the Forschende Komplementärmedizin underline the fact that the HTA reports of the PEK project underwent a multi-stage quality assurance procedure, which means that the quality of their information can be regarded as scientifically confirmed.

Clear evidence found for the effectiveness of homeopathy

The Swiss HTA report exhaustively reviews the clinical research in homeopathy (both systematic reviews and the original clinical studies). It includes an overview of 22 systematic reviews of clinical trials, 20 of which show a positive direction of evidence for homeopathy. To quote the authors, “Conclusion after revision of reviews on homeopathy: on our three-tier evaluation scale (‘likely, Questionable, unlikely’), the effectiveness of homeopathy has to be rated as ‘likely’.”

They then mention that, “The large majority of studies mentioned in systematic and other reviews
were carried out according to conventional medical standards as justification research, with a view to attaining outer recognitionfor homeopathy. Homeopathically speaking, most of these studies were conducted with inadequate, not practice-relevant methods, because their design ignores essential tenets of homeopathy, thus causing low model validity and a high risk of false-negative results.”
The authors also provide an extensive review of the evidence for the effectiveness of homeopathy for Upper Respiratory Tract Infections and Allergic Reactions (URTI/A). They identified 29 studies pertaining to this subject with 24 of them showing positive results. They submitted the data to a number of different analyses to identify potential sources of error. They concluded,“the trial results showed probable effectiveness of homeopathy for allergies and infectious diseases of the upper respiratory tract’.
Conclusions of The Lancet 2005 meta-analysis strongly undermined The report also sheds light on the meta-analysis of Homeopathy published in The Lancet in 2005, which was heralded by the
Lancet’s editor as “The end of homeopathy”. According to theauthors, the Shang et al. study was originally commissioned by the FSIO as a part of this same HTA assessment of CAMs. The authors carefully analyse the Lancet study, concluding: “Whilethe above argument does not allow us to draw the reverse conclusion that homeopathy is effective, it does support the claim that the Shang et al. study 2005 does not prove the ineffectiveness of homeopathy”. These remarks strongly
undermine the conclusions of the Lancet 2005 meta-analysis, which, to date, remains the only comprehensive systematic review ever to conclude that the clinical effects of homeopathyare likely to be due to placebo.

Comments on the evidence base for homeopathy
On the subject of preclinical research, the authors conclude, “The tenet of homeopathy that very high dilutions of medicinal substances (homeopathic potencies) are able to induce specific effects in living organisms is supported by quite a large number of high-quality trials in fundamental preclinical research.
[...] Fundamental preclinical research is unable to supply statements regarding the other mainstays of homeopathy: the simile principle and drug proving on the healthy subjects.”

Looking at the general state of the research in homeopathy the authors comment, “Since its inception over 200 years ago,homeopathy has been based on empirical research. Apart from this system-immanent research, homeopathy has so far lacked a tradition of systematic research.[...] the practice
of homeopathy gains little from conventional trials. There is no interested pharmaceutical industry nor are there potent sponsors; research infrastructures and appropriate research concepts are also lacking.”
On the topic of cost effectiveness of homeopathy the authors agree with the conclusions of a previous review by Maxion-Bergmann et al. stating, “Available data suggest potential costsavings due to the use of homeopathy. Further well-designed studies and analyses of existing databases for homeopathy are
encouraged in order to support informed decisions in European health care-systems.”

Regarding the variability of study results the authors comment,“The numerous reviews that exist now on homeopathy often evaluate (overtly or covertly) the ‘vote count’ i.e. the number of positive and negative study results are added up and the sum total is presented as the final result: a method that we did not use in the present HTA. Positive results were instead examinedfor the risk of bias and their plausibility and an effectiveness evaluation was established on the basis of content.” They add, “It is like drawing the conclusion, after observing 2 black swansand 5 white swans, that there are no black swans as 2-5=-3. This happens in a simple vote count or in other statisticaladditive procedures without thematic differentiation.”

This authoritative report has informed the decision taken by the Swiss government to include homeopathy (and four other CAM therapies) on the list of services covered by the Swiss statutory health insurance scheme until 2017. We would hope that health authorities in the UK and elsewhere will consider the recommendations of this report when reviewing the role homeopathy has to play in statutory healthcare.

Extract from The Homeopathy Research Institute Spring Newsletter 2012.

Read the whole text here
‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety,
Costs’ by Gudrun Bornhöft and Peter F. Matthiessen (Editors). 2011.
ISBN 978-3-642-20637-5.


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