As chief executive of the Homeopathy Research Institute, Rachel Roberts wasn't exactly holding her breath when she heard that the Australian government was the latest to carry out a major review of the therapy. After all, homeopathy has been the punching bag of conventional medicine for years, and objective science seems to go out the window when it's assessed. This is usually because it seems to be so implausible—any active ingredient is diluted out of all existence—that evidence suggesting it works must be false.
But she knew there were at least three rock-solid studies—demonstrating, among other things, that homeopathy is effective against hay fever, sinusitis and diarrhoea in children—that couldn't be ignored.
Yet, when the review from Australia's National Health and Medical Research Council (NHMRC) was published in 2015, these studies weren't included. In fact, just five trials—and none that Ms Roberts had identified—were considered of a high-enough standard to even be considered, and not one of these found that homeopathy worked. "There are no health conditions for which there is reliable evidence that homeopathy is effective," the report's researchers stated.
Worse, not only is homeopathy a placebo—in other words, any benefits are entirely due to the imagination of the patient—"people who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness", the report added.
The world's media had a field day. Homeopathy was derided as everything from a con or a trick to being a killer and, emboldened by this response, Professor Paul Glasziou, who headed up the NHMRC study, urged pharmacies to stop stocking homeopathic remedies.
"We hope there will be a lot of reasonable people out there who will reconsider selling, using or subsidizing these substances," he said.1
But what did happen to the good, solid studies that the NHMRC left out? In Australia, Gerry Dendrinos, vice president of the Australian Homeopathic Association, was having similar doubts about the review. He already knew the research council wasn't an independent arbiter: back in 2010, it had prepared a draft position statement that described homeopathy as unethical, inefficacious, implausible and deceptive. The NHMRC's former chief executive officer, Prof Warwick Anderson, also weighed in, and called homeopathy "a retreat from reason" and an "alleged therapy".
But because such comments were criticized for being biased and unscientific, Prof Anderson agreed to carry out a formal review of homeopathy. He set up a Working Group chaired by Prof Peter Brooks, who had signed an official declaration that he was not "affiliated or associated with any organization whose interests are either aligned with or opposed to homeopathy".
But he hadn't revealed that he was a member of Friends of Science in Medicine, which is opposed to homeopathy and was already lobbying members of the Working Group. When this affiliation was exposed, Prof Brooks stepped down as chairman, but remained in the group. In addition, the Working Group failed to include one single expert in homeopathy, thus breaching NHMRC guidelines for creating specialist committees.
Meanwhile, Dendrinos had uncovered something rather strange: the NHMRC working party had already prepared a review that was never published. That previous report had found evidence that homeopathy did work, but it was rejected because it was deemed to be of "poor quality"—and it has been suppressed ever since, even in the face of Freedom of Information requests.
Digging deeper, Dendrinos found that the first review had included papers that fell short of the arbitrary quality threshold the Working Group had since created. For one, it excluded any trial that had fewer than 150 participants—even though there is no valid scientific reason for this—and every paper had to meet the highest possible mark in a rating system known as the Jadad scale, which even most drug trials fall short of achieving.
What's in a number?
In the new movie Just One Drop, Dendrinos is filmed talking on the telephone to Dr Nikolajs Zeps, one of the NHMRC reviewers, about the 150-person threshold. Zeps admitted it could have been lower—but had that happened, many more good studies would have been included. When pressed by Dendrinos, Zeps threatened to end the call if Dendrinos persisted with this line of questioning.
The NHMRC also gave the impression it had "rigorously assessed" more than 1,800 studies of homeopathy before finally paring them down to just five. It hadn't. Because so many couldn't meet their exacting quality standards, only 267 studies were even considered and, of those, only 176 were actually assessed—with all but five of these dismissed as "unreliable". But even then, the researchers hadn't read any of the original papers but, instead, relied solely on summaries prepared by other researchers.
Homeopaths weren't the only ones concerned about the methods adopted by the reviewers. The NHMRC's own expert independent reviewer from the Australian Cochrane Collaboration thus expressed his worries: "If the intent is to provide general statements about the effectiveness of homeopathy, then 'no reliable evidence' may not adequately reflect the research. For example, when a substantial proportion of small (but good-quality) studies show significant differences, 'no reliable evidence' does not seem an accurate reflection of the body of evidence," he wrote.2
For this reason, the Homeopathy Research Institute teamed up with the Australian Homeopathic Association to produce a report looking into the NHMRC review that has been submitted to the Commonwealth Ombudsman, which investigates complaints against any Australian government agency.
Ms Roberts said: "NHMRC's review is just bad science. Decision-makers and the scientific community rely on these kinds of reports and need to trust their accuracy. If the evidence on conventional medicine was treated this way, there would be an outcry."
But then, it probably wouldn't be reviewed by an Australian kangaroo court.
To find out more about the Just One Drop movie, go to: www.justonedropfilm.com.
The evidence they ignored
The Australian Homeopathy
Research Institute's Rachel Roberts knows of at least three good-quality studies demonstrating that homeopathy works—all of which were ignored by the NHRMC reviewers (see main story).
The first, published in the prestigious journal The Lancet in 1986, tested a homeopathic remedy against a placebo in 144 people suffering from acute hay fever. Those given the remedy showed a "significant reduction" in symptoms, and their use of antihistamines was halved. "No evidence emerged to support the idea that placebo action fully explains the clinical responses to homeopathic drugs," the reviewers concluded.1
The second report reviewed the effectiveness of homeopathy for treating childhood diarrhoea. A group of 242 children, aged six months to five years, were given either a homeopathic remedy or a placebo and, thereafter, their diarrhoea was monitored. The children given homeopathy suffered from diarrhoea for 3.3 days whereas it lasted 4.1 days in the placebo group. "The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhoea . . . Homeopathy should be considered for use as an adjunct to oral rehydration for this illness," concluded the researchers.2
In the third paper, homeopathy was tested against a placebo as a treatment for acute sinusitis. A group of 57 patients was given the remedy Sinfrontal, while 56 were given a placebo instead. Within seven days, the homeopathy group saw a "significant reduction" in their symptoms, and 68 per cent enjoyed complete remission within three weeks (vs 9 per cent of those taking the placebo).3
It works—even though it can't
The NHMRC isn't the first to carry out a 'review of reviews' of homeopathy. This also happened back in 1991, when researchers looked at 101 trials that passed criteria for 'good science'—including those that were double-blind (no one knew whether they were taking a homeopathic remedy or a dummy pill), randomized (people were chosen at random to be given the remedy or the dummy treatment) and with large sample populations—and found that 81 concluded that homeopathy works. The authors said that "based on this evidence, we would be ready to accept that homeopathy can be efficacious, if only the mechanism of action were more plausible."1
Five years later, the European Commission set up an independent Homeopathic Medicine Research Group, including researchers from the fields of homeopathy and conventional medicine, to look at the evidence. They identified 184 controlled trials and found "some evidence" that homeopathy works.2
Medical researcher Klaus Linde then also carried out several reviews and meta-analyses, and concluded that the results "are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo".3
However, an especially controversial report was a "comparative study" by Aijing Shang and colleagues at the University of Berne. They looked at 110 homeopathy trials and compared the results to those from 110 trials of conventional drug treatments, and concluded that any homeopathic evidence was mainly down to "placebo effects".4
Yet, in response, Peter Fisher of the Royal London Homeopathic Hospital pointed out that their conclusion was not based on 110 reports, but on only eight homeopathy trials and six of conventional medicines. And although Shang and his team refused to reveal how they came to select just those few papers, they did admit that the homeopathy ones were of higher quality—and higher-quality trials are known to be less likely to produce positive results.
Also, the researchers refused to reveal which eight homeopathic trials were ultimately selected.5