"The most comprehensive systematic review is the German report, commissioned the Instute KIKOM showing that homeopathy works beyond the placebo. Ernst and D. Sahw tried to attack the study, however the authors of the report refuted each of their claims."
This would appear to be a reference to the infamous Swiss - not German - Government homeopathy HTA (as it is commonly referred to by homeopaths), which was neither published by the Swiss Government nor was an HTA.
Neither was it a systematic review, but a limited literature review in which the authors (mainly homeopaths, two of whom were associated with KIKOM, the Institute for Complementary Medicine) chose to 're-interpret' the conclusions of previous meta-analyses, in the direction of being more positive of homeopathy. This re-assessment was criticised by the PEK (Programm Evaluation Komplementärmedizin) set up by the Swiss Government to assess the evidence for homeopathy in terms of appropriateness, comparative effectiveness, risk-benefit-ratio and cost-effectiveness. The Shang et al. matched trials and meta-analysis was another part of the PEK's overall investigation into homeopathy and other alternative therapies.
However, the homeopathy report, eventually published in English in 2011 [1], wasn't even the same report that was submitted to the PEK, but one that was added to by its editors. Felix Gurtner of the Federal Office of Public Health FOPH, Health and Accident Insurance Directorate, Bern, Switzerland stated it was:
"a broad analysis of the literature incorporating publications and unpublished reports on studies of various methodologies (randomised and non-randomised trials, case series, experimental studies). This review was declared to be an HTA by the authors (the final PEK report does not classify the literature reviews as HTA reports) and published later as a book under their responsibility without any consent of the Swiss government or administration. The book by Bonhöft and Matthiessen was later translated into English and published in 2012." (Reference numbers removed to avoid confusion.) [2]
The PEK disagreed with the somewhat rosy tint that the report's authors put on homeopathy and, as a result, the Swiss Government removed homeopathy from its state reimbursement scheme. It wasn't until after much campaigning and a referendum that the Government agreed to allow reimbursement, but only for a temporary period with the condition that unless scientific evidence for homeopathy was provided by 2015, reimbursement would finally end in 2017.
So, even though Ernst criticised the report, [3] it was the Swiss Government PEK that first and most damningly criticised it, saying:
"For all five assessments, it is very obvious that all or some of the authors have a positive attitude towards the treatments in question or are convinced about their efficacy. Unquestionably, strict proponents of the usual hierarchy of evidence will regard the presented evaluations as scientifically untenable and unreasonably positive (except for some specific aspects of phytotherapy). Even less skeptical academic doctors will regard many interpretations as very optimistic and not scientifically convincing."
and
"The positive interpretation of the current evidence seems understandable, as long as one does not require especially high evidence standards, given the low plausibility of homeopathy in the light of established scientific knowledge. Very skeptical people will regard the reviewed evidence as not very convincing." [4]
In response to the report's authors' comments that Zetetic150 mentions, Ernst said:
"I am grateful to the authors of this response. A careful assessment of their arguments will convince any critical evaluator that the HTA is, in fact, a thinly disguised attempt to generate a positive overall impression for homeopathy in the absence of convincing evidence for its therapeutic value." [5]
Zetetic150's 'comprehensive systematic review...showing that homeopathy works beyond the placebo' is nothing of the sort and I wait with bated breath to see what scientific evidence is presented to the Swiss Government in 2015.
1 Bornhöft, Gudrun, Peter F Matthiessen, and SpringerLink (Online service). 2011. Homeopathy in Healthcare -- Effectiveness, Appropriateness, Safety, Costs an HTA Report on Homeopathy as Part of the Swiss Complementary Medicine Evaluation Programme. Berlin: Springer. http://dx.doi.org/10.1007/978-3-642-20638-2.
2 Gurtner, F. 2012. “The Report ‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs’ Is Not a ‘Swiss Report’.” Swiss Medical Weekly (December 17). doi:10.4414/smw.2012.13723. http://www.smw.ch/content/smw-2012-13723/.
Rapid Response:
Re: Good medicine: homeopathy
Zetetic150 said:
"The most comprehensive systematic review is the German report, commissioned the Instute KIKOM showing that homeopathy works beyond the placebo. Ernst and D. Sahw tried to attack the study, however the authors of the report refuted each of their claims."
This would appear to be a reference to the infamous Swiss - not German - Government homeopathy HTA (as it is commonly referred to by homeopaths), which was neither published by the Swiss Government nor was an HTA.
Neither was it a systematic review, but a limited literature review in which the authors (mainly homeopaths, two of whom were associated with KIKOM, the Institute for Complementary Medicine) chose to 're-interpret' the conclusions of previous meta-analyses, in the direction of being more positive of homeopathy. This re-assessment was criticised by the PEK (Programm Evaluation Komplementärmedizin) set up by the Swiss Government to assess the evidence for homeopathy in terms of appropriateness, comparative effectiveness, risk-benefit-ratio and cost-effectiveness. The Shang et al. matched trials and meta-analysis was another part of the PEK's overall investigation into homeopathy and other alternative therapies.
However, the homeopathy report, eventually published in English in 2011 [1], wasn't even the same report that was submitted to the PEK, but one that was added to by its editors. Felix Gurtner of the Federal Office of Public Health FOPH, Health and Accident Insurance Directorate, Bern, Switzerland stated it was:
"a broad analysis of the literature incorporating publications and unpublished reports on studies of various methodologies (randomised and non-randomised trials, case series, experimental studies). This review was declared to be an HTA by the authors (the final PEK report does not classify the literature reviews as HTA reports) and published later as a book under their responsibility without any consent of the Swiss government or administration. The book by Bonhöft and Matthiessen was later translated into English and published in 2012." (Reference numbers removed to avoid confusion.) [2]
The PEK disagreed with the somewhat rosy tint that the report's authors put on homeopathy and, as a result, the Swiss Government removed homeopathy from its state reimbursement scheme. It wasn't until after much campaigning and a referendum that the Government agreed to allow reimbursement, but only for a temporary period with the condition that unless scientific evidence for homeopathy was provided by 2015, reimbursement would finally end in 2017.
So, even though Ernst criticised the report, [3] it was the Swiss Government PEK that first and most damningly criticised it, saying:
"For all five assessments, it is very obvious that all or some of the authors have a positive attitude towards the treatments in question or are convinced about their efficacy. Unquestionably, strict proponents of the usual hierarchy of evidence will regard the presented evaluations as scientifically untenable and unreasonably positive (except for some specific aspects of phytotherapy). Even less skeptical academic doctors will regard many interpretations as very optimistic and not scientifically convincing."
and
"The positive interpretation of the current evidence seems understandable, as long as one does not require especially high evidence standards, given the low plausibility of homeopathy in the light of established scientific knowledge. Very skeptical people will regard the reviewed evidence as not very convincing." [4]
In response to the report's authors' comments that Zetetic150 mentions, Ernst said:
"I am grateful to the authors of this response. A careful assessment of their arguments will convince any critical evaluator that the HTA is, in fact, a thinly disguised attempt to generate a positive overall impression for homeopathy in the absence of convincing evidence for its therapeutic value." [5]
Zetetic150's 'comprehensive systematic review...showing that homeopathy works beyond the placebo' is nothing of the sort and I wait with bated breath to see what scientific evidence is presented to the Swiss Government in 2015.
1 Bornhöft, Gudrun, Peter F Matthiessen, and SpringerLink (Online service). 2011. Homeopathy in Healthcare -- Effectiveness, Appropriateness, Safety, Costs an HTA Report on Homeopathy as Part of the Swiss Complementary Medicine Evaluation Programme. Berlin: Springer. http://dx.doi.org/10.1007/978-3-642-20638-2.
2 Gurtner, F. 2012. “The Report ‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs’ Is Not a ‘Swiss Report’.” Swiss Medical Weekly (December 17). doi:10.4414/smw.2012.13723. http://www.smw.ch/content/smw-2012-13723/.
3 Edzard Ernst. 2012. “A Critique of the Swiss Report Homeopathy in Healthcare - Ernst - 2012 - Focus on Alternative and Complementary Therapies - Wiley Online Library.” Accessed June 2. http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2012.01160.x/full.
4 “That ‘neutral’ Swiss Homeopathy Report | Zeno’s Blog.” 2013. Accessed January 29. http://www.zenosblog.com/2012/05/that-neutral-swiss-homeopathy-report/. Swiss German translations by Sven Rudloff.
5 Ernst, Edzard. 2013. “Response from Edzard Ernst.” Focus on Alternative and Complementary Therapies 18 (2): 110–110. doi:10.1111/fct.12025_2.
Competing interests: Director of the Nightingale Collaboration, which challenges misleading healthcare claims.