Lex Rutten, Erik Stolper, David Spence, David Reilly, Ton Nicolai
It seems highly unlikely, but the editors of the first-class medical Journal ‘the Lancet’ were in our opinion cheated likewise and then went on to propose that this will mean the end of homeopathy. On August 27th 2005, the Lancet published a study, which, they said, proves that homeopathy is nothing more than a placebo effect.
Editors of a first class medical journal, such as the Lancet, can accept that the most vital data of the study are kept a secret. The authors have obviously not been honest and concealed the fact that the management of the PEK programme had provided strong criticism. This criticism is stated in the final report, which is dated April 24, 2005
We have little knowledge of the underlying mechanisms of homeopathy. The theory that toxic materials can also cure is commonly accepted, for example in vaccination. But the concept that homeopathic medicinal products are still effective after a gradual process of high dilution and intensive succussion is beyond the bounds of current scientific understanding. Still this method has been used worldwide for centuries, especially by patients with chronic complaints.
These patients have had wide experience with conventional medicine and have observed that conventional medicinal products may reduce their symptoms to some extent, but their complaints often recur. Such patients have found that, by using homeopathic treatment, their complaints may disappear completely, while the treatment hardly ever causes any serious side effects. In 1999 a number of complementary forms of medicine, of which homeopathy was one, were experimentally included in the Swiss health insurance. Meanwhile a large research program with numerous research institutes was started to study the effectiveness and cost-effectiveness of these complementary treatments. The program was called Programm Evaluation Komplementärmedizin (PEK). One of the institutions was the Institut für Sozial und Preventiv Medizin (ISPM).
This institution carried out the meta-analysis, recently published in the Lancet, and which is further discussed in this paper. However, the outcome of the meta-analysis was previously announced in the public press back in August 2003. The methods and the conclusion of this meta-analysis in particular, received a lot of criticism from the PEK management. The PEK management observed that different treatments for different diseases cannot be approached as if you are looking at one treatment for one disease. This criticism is not even mentioned in the Lancet publication, let alone discussed.
Earlier analysis investigating the specific effects of homeopathy has shown that existing evidence for the efficacy of homeopathy can compete with evidence for conventional medicine. From the Lancet paper it can be concluded that the placebo-controlled clinical trials on homeopathy are of higher quality and are less heterogeneous than conventional studies. In addition, the decrease in effect size with increasing quality of the studies might be less for homeopathy than for conventional medicine.
A third conclusion that can be drawn from the paper is that homeopathy is specifically effective for upper respiratory tract infections. According to the methods of the science philosopher Popper, which are the basis of the current double-blind placebo-controlled trials, evidence is now provided that homeopathy is more than a placebo effect: the hypothesis that swans are all white is falsified, as soon as the first black swan is found.
The paper, as published in the Lancet, by a scientist who is biased and not objective, has tried to come
to a different conclusion. In doing so he has shown graphs that are not coherent with the conclusion drawn from these graphs, he has not identified which 8 studies were part of the sub-analysis and he has not taken into account, nor mentioned, the criticisms of the PEK commission itself. According to the commission, the heterogeneity as found in the sub-analysis of 8 studies is caused by the heterogeneity of the selection of the studies itself.
The editors of the Lancet have made a critical mistake in accepting the paper for publication since the readers are not able to follow the arguments that lead to the conclusions. The statement of the editors in the same edition of the Lancet that this publication should mean the end of homeopathy is biased; in fact, the paper proves the opposite.
For more than 15 years now, discussion and research effort have been directed towards proving that homeopathy is nothing more than a placebo effect. However, the arguments and analysis that have emerged, purporting to prove that this is the case, have failed to do so and have, at the same time, called into question the efficacy of conventional medicine just as much.
We are painfully aware of the theoretical problem. The fact that the mechanism of action is hardly investigated is due to the fact that politicians and conventional medicine explicitly asked for RCT proof. The RCT proof being delivered implausibility is put forward to reject this proof.
Maybe we should have invested all our efforts in finding the mechanism of action. Meanwhile, research into the mechanism of action has started. There are indications that the succussion induces some physical information that remains despite the dilution. [Read full article]