The home of two pharmaceutical giants comes out strongly in favour of homeopathy, legalizing national-health reimbursement
The most comprehensive assessment ever conducted by any governmental body into homeopathy has concluded that not only does it work, but that it is far more cost-effective than conventional medicine. In fact, it works so well that patients should be reimbursed for it on the National Health.
In a rare departure from its history of neutrality on many issues, the Swiss government conducted a detailed inquiry into homeopathy and other alternative therapies largely in response to their wide-spread use by both doctors and patients.
Remarkably, nearly two-thirds of all medical practitioners in Switzerland rate alternative medicine, about 40 per cent use it and 85 per cent of the country wants their country's national health to include these therapies.
The study follows the 1998 decision by the Swiss government to expand its national insurance to include a number of alternative treatments, such as homeopathy, traditional Chinese medicine, and herbal and anthroposophical medicine. Nevertheless, government reimbursement was provisional, pending the outcome of an extensive government-commissioned study of the various treatments.
Assessing the evidence
The task fell to the Swiss Network for Technology Health Assessment created by the government in 1999 to determine the best value for money invested on health.
The book-length report, called Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs, edited by Gudrun Bornh"oft and Peter F. Matthiessen, from both the University of Witten/ Herdecke in Germany and PanMedion Foundation in Zurich, comprehensively reviewed all the major evidence for homeopathy from major preclinical research (human cell lines, in plants and animals, and biochemical findings) and the big 'gold-standard' trials in humans-the randomized, double-blind, placebo-controlled ones-to systematic reviews, meta-analyses and epidemiological studies.
The report's methodology had been used by the UK's National Institute for Health Research as a means of assessing true effectiveness, safety and cost-effectiveness of the treatments available from the National Health Service. It has also been widely adopted by many other international agencies.
The Swiss scientists had two major criteria for judging study quality: internal validity (quality of the study design and execution); and external validity (how accurately the studies reflect the use of homeopathy in real life).
Evaluating external validity is particularly crucial as research into homeopathy is often done by doctors and scientists with little understanding of how it should be used or which treatments work best for which patients. Many high-profile studies purporting to debunk treatments like homeopathy are essentially set up to fail because the researchers essentially don't know what they're doing.
Often, the researchers use the wrong remedy or use it inappro-priately. Some homeopathy studies have attempted to use a 'one-size-fits-all' remedy for a condition, when it is widely understood that many conditions require individualized remedies.
After assessing all the available data, the Swiss team concluded that the high-quality investigations of preclinical basic research proved that homeopathic high-potency remedies induce "regulative and specific changes in cells or living organisms".
Of the systematic reviews of human research, said the report, 20 out of 22 detected "at least a trend in favour of homeopathy", and five showed "clear evidence for homeopathic therapy".
The report found particularly strong evidence for the use of homeopathy for upper respiratory tract infections (URTIs) or allergic reactions: of studies showing a positive overall result in favour of homeopathy, six out of every seven showed at least equivalence to conventional interventions and, of 16 placebo-controlled studies, half showed significant results with homeopathy.
Perhaps most significantly, the report concluded that the effectiveness of homeopathy "can be supported by clinical evidence" and "regarded as safe". Applied properly, it said, "classical homeopathy has few side-effects and the use of high potencies is free of toxic effects" (Forsch Komple-mentmed, 2006; 13 Suppl 2: 19-29).
Bornh"oft and Matthiessen concluded there was "sufficient evidence" for the "clinical efficacy of homeopathy and for its safety and economy compared with conventional treatment".
The Swiss government also examined whether homeopathy was saving or costing money by studying data from Swiss health insurers, including all costs for consultations, medications, physiotherapy and laboratory analyses.
As it turned out, doctors who specialized in homeopathy cost at least 15-per-cent less than conventional doctors, even though those seeking homeopathy tended to have more chronic or serious ill health-factors that would usually translate into bigger health bills.
When treatments for specific illnesses were compared, homeopathy again proved cost-saving: children with URTIs had fewer recurrences of illness and required fewer antibiotics than those receiving conventional drugs.
Homeopathy led to less dependence on drugs. In more than 500 patients with rheumatic disease, nearly a third were able to stop taking conventional medication, and another third reduced their use of drugs.
Homeopathic fertility treatment for women offered one of the largest cost-savings of all compared with standard medical treatments.
Homeopathy also saved on hospital bills: female patients using homeopathic doctors were six times less likely to land in hospital than those using conventional doctors.
There were also many indirect cost-savings, such as fewer days off sick, with patients opting for homeopathy.
Furthermore, homeopathy users reported fewer side-effects and better doctor-patient relationships. On comparing patient satisfaction with homeopathic vs conventional therapies in more than 3000 subjects, significantly more homeopathic patients (53 per cent) were "completely satisfied" compared with 43 per cent of those taking conventional medicines (BMC Complement Altern Med, 2008; 8: 52).
Alternatives as mainstream
The Swiss are leading the way in the integration of alternative therapies into mainstream healthcare. Following a national referendum in 2009, where a two-thirds majority voted to integrate complementary and alternative medicine into the Swiss healthcare system, the Swiss Minister of Health approved reimbursable payment for five of the most popular alternatives: homeopathy; herbal medicine; traditional Chinese medicine; anthroposophical medicine; and neural therapy (based on the idea that trauma produces disturbances in the electrochemical functioning of tissues).
Perhaps the most remarkable aspect of all this is not simply that, as a result of the new report, homeopathy is now enshrined in the Swiss constitution and paid for by public money, but that this has happened in a land where two of the top largest pharmaceutical firms have their base.
It has also occurred at precisely the point where EU initiatives (of which Switzerland is a part) funded by the pharmaceutical industry are busily banning or drastically curtailing the availability of nutritional supplements and many alternative treatments despite their long history of success.
To paraphrase the words of Mark Twain, the Swiss are sending a firm message to the pharmaceutical giants, in their continued attempts to discredit alternative medicine, that reports of its death are greatly exaggerated.
Factfile: Not quite the end yet
The Swiss government's report was particularly scathing about the 2005 meta-analysis by Shang et al., which was published in the Lancet and widely publicized by sceptics of alternative medicine as signalling the "end of homeopathy".
In the Shang study, the scientific team evaluated 110 clinical trials of homeopathy and then compared them with the same number of trials of conventional medicine. Although the aim was ostensibly to compare the 22 high-quality homeopathic trials with nine high-quality conventional studies, the team devised a set of criteria to eliminate the majority of the best homeopathic trials, thereby supporting their conclusion that homeopathy doesn't work.
As the Swiss authors noted, Shang and colleagues neglected to follow the basic accepted QUOROM (quality of reporting of meta-analyses) guidelines on best practices for scientific reporting (Forsch Komplementmed, 2006; 13 Suppl 2: 19-29).
The Swiss report also quoted the views of Canadian Dr David Sackett, considered one of the leading experts in 'evidence-based medicine', who argued that the 'gold-standard' study-the randomized, placebo-controlled trial-may not be the only means of judging the safety and effectiveness of a treatment; it certainly could not be used to evaluate surgery, for example.