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Homeopaths Without Borders practice exploitation not humanitarianism

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5448 (Published 17 September 2013) Cite this as: BMJ 2013;347:f5448

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Re: Homeopaths Without Borders practice exploitation not humanitarianism

Jahnig said:

"It is somewhat ironic that Mr. Henness and Mr. Chapman would imply the findings of the Swiss HTA weren't valid by claiming it was "written by homeopaths""

The Swiss homeopathy wasn't poor because it was written by homeopaths; it was poor because it was flawed, [1,2] as I have already pointed out. [3] However, it should be noted that Shaw commented on the authors' undeclared COIs.

But can we finally put to bed the idea that this was an HTA? It was not and this has been stated by the Swiss Government in the reference I have already provided. [4]

To make it clear, the author of that letter was Felix Gurtner, Federal Office of Public Health FOPH, Health and Accident Insurance Directorate, Bern, Switzerland. He clearly stated that the homeopathy report was simply one of several literature reviews and:

"the final PEK report does not classify the literature reviews as HTA reports"

If Jahnig believes Dr Gurtner is mistaken, I would suggest she presents her argument.

We did not know this at the time Sven Rudloff and I wrote our blog post, [5] so we have, unfortunately, propagated this error.

Jahnig continues:

"while, at the same time, offering up criticisms of the study made by people well known for their own personal bias against homeopathy -- one being Edzard Ernst."

That will not do here. If you believe Prof Ernst was biased in some way, please bring specific allegations to our attention, giving details from the paper I cited, so they can be critically examined.

"It's hard to know why David Shaw would be commenting on homeopathic research."

I assume that would be because Dr Shaw is an expert in bioethics and this is clearly a bioethics issue.

"He is a bioethicist not trained in medical research and not trained in homeopathic research. His resume includes working as a moral philosophies tutor, an English instructor and a lecturer in ethics at the Dental School, U. of Glasgow. His papers include "Cryogenics: Seeking life after death" and "We should not let families stop organ donation from their dead relatives". Mr. Henness even offers his own comments as a reference. I'm curious about his credentials as a medical or homeopathic researcher."

Ad hominems and attempts to poison the well will not work here. If you have an issue with specific details where you believe Dr Shaw has erred, I'm sure readers will be interested to hear about them.

Similarly, my credentials are irrelevant; what matters is whether sound arguments are presented and whether they can be countered with evidence. I note that Jahnig has not done this. Our blog post is well referenced to source documents, allowing any reader to verify what we say - assuming they can understand formal Swiss-German. However, if Jahnig can point out any errors we made, we will be only too happy to correct them.

"Gudrun Bornhoft, M.D., and Peter Matthiessen, M.D., were the editors of the Swiss HTA. The study itself was conducted by appropriately qualified professionals without a vested interest. The investigating team was composed of 13 members. Ten are trained in conventional medicine. Of them six are also trained in homeopathy. The other three are trained in physics, electrical engineering and sociology. 8 of the thirteen held academic positions. Six were involved in CAM research."

Interesting, but irrelevant. Let's also be clear that the document Jahnig refers to, written in English, is not the literature review written for the Swiss PEK. The English version was added to by its editors and published "without any consent of the Swiss government or administration". [4]

"The study analyzed all of the homeopathic literature over the past 40 years not just literature on respiratory infections and allergies."

Out of the 218-page report, the authors devote just 23 pages to the examination of the literature on the clinical efficacy of homeopathy. Titled 'Overview of Systematic Reviews on the Clinical Efficacy of Homeopathy', its two authors, Gudrun Bornhöft and Klaus v. Ammon, searched the literature for systematic reviews and meta-analyses, but only those published after 2000. The authors do list several papers that looked at a variety of indications, but, of these nine, other than providing a short description of each, they only present their comments on one of them. The following chapter, Chapter 10, "Clinical Studies on the Effectiveness of Homeopathy for URTI/A (Upper Respiratory Tract Infections and Allergic Reactions)" spends 29 pages examining trials for just these two conditions.

It is interesting to note how many of the original studies’ conclusions the homeopathy report ‘re-interpreted’ to be more favourable towards homeopathy, and their attempted justification for doing so. This was noticed by the PEK who marked them back down again, giving rise to my previous quotes from them.

"The results of the HTA are "Many high quality investigations of pre-clinical basic research proved homeopathic high potencies inducing regulative and specific changes in cells or living organisms. 20 of 22 systematic reviews detected at least a trend in favor of homeopathy. In our estimation 5 studies yielded results indicating clear evidence for homeopathic therapy. The evaluation of 29 studies in the domain 'Upper Respiratory Tract Infections/Allergic Reactions' showed a positive overall result in favor of homeopathy. 6 out of 7 controlled studies were at least equivalent to conventional interventions. 8 out of 16 placebo-controlled studies were significant in favor of homeopathy. Swiss regulations grant a high degree of safety due to product and training requirements for homeopathic physicians. Applied properly classical homeopathy has few side effects and the use of high potencies is free of toxic effects. Taking external and internal validity into account, effectiveness of homeopathy can be supported by clinical evidence and professional and adequate applications be regarded as safe.""

As I have already pointed out, the Swiss homeopathy report has been widely criticised; it would be more fruitful and would help further the discussion if Jahnig could address those criticisms.

For those who might not be aware, the result of the Swiss homeopathy report was that the Swiss Government ended the temporary reimbursement of homeopathy in the state health insurance scheme.

1. Edzard Ernst. 2012. “A Critique of the Swiss Report Homeopathy in Healthcare - Ernst - 2012 - Focus on Alternative and Complementary Therapies - Wiley Online Library.” http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2012.01160.x/full.

2. “SMW - Swiss Medical Weekly - The Swiss Report on Homeopathy - a Case Study of Research Misconduct.” 2012. http://www.smw.ch/content/smw-2012-13594/.

3. “Re: Homeopaths Without Borders Practice Exploitation Not Humanitarianism | BMJ.” 2013. October 12. http://www.bmj.com/content/347/bmj.f5448/rr/666410.

4. 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/.

5. Henness, Alan, and Rudloff, Sven. 2013. “That ‘neutral’ Swiss Homeopathy Report | Zeno’s Blog.” http://www.zenosblog.com/2012/05/that-neutral-swiss-homeopathy-report/.

Competing interests: Director of the Nightingale Collaboration, which challenges misleading healthcare claims.

15 October 2013
Alan Henness
Director
The Nightingale Collaboration
BM The Nightingale Collaboration, London WC1N 3XX