Latest News:21 January 2014The Lancet's 2005 Shang et al study shown yet again to be methodologically faulted. 27 November 2013
Hahn, a Swedish anesthesiologist and researcher of 30 years experience, who has never studied or practised homeopathy, recently published a new critique of three of the main meta-analyses of homeopathy that are usually cited as not being supportive of a therapeutic effect beyond placebo. Hahn details the Linde (1997), Cucherat (2000) and Shang (2005) analyses, highlighting their flaws and weaknesses.
The Shang et al study, which has been used endlessly by homeopathy's critics to support their flawed cases, has already been shown by other critics to be deeply faulted. (Ludtke R, Rutten AL: The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J Clin Epidemiol 2008;61:1197–1204.)
Hahn concludes: Clinical trials of homeopathic remedies show that they are most often superior to placebo. Researchers claiming the opposite rely on extensive invalidation of studies, adoption of virtual data, or on inappropriate statistical methods. Further work with meta-analyses should abandon the concept of summarizing all available clinical trials and focus on the effects of homeopathy versus placebo or other treatments in specific diseases or groups of diseases. One way to reduce future emotional- driven distortion of evidence by investigators and skeptics would be to separate the evidence-seeking process from the formulation of clinical guidelines more clearly.
For the abstract and to obtain a full copy of the article go here: http://www.karger.com/Article/FullText/355916
Reference: Hahn, R.G., 2013. Homeopathy: Meta-Analyses of Pooled Clinical Data. Forshende Komplementarmedizin; 20(5):376-381
New Report on the Availability of Homeopathic Medicines in the EU Launched in the European Parliament: the report reveals an unsatisfactory situation
A copy of the full report and its different annexes can be found here: http://www.echamp.eu/publications/special-reports/availability-report.html
On 26 November Dr Thomas Ulmer MEP (Germany) hosted a meeting in the European Parliament to launch a new report on the availability of homeopathic medicines in Europe. Produced by the European Coa
lition for Homeopathic and Anthroposophical Medicinal Products (ECHAMP), the report is the result of a comprehensive survey of the situation facing citizens, providers and manufacturers with regards to provision of such medicines in the EU pharmaceutical market. The market for homeopathic and anthroposophic medicinal products is worth 1 billion euros in Europe - with a better regulatory situation it would be much higher,.
Speakers in the meeting included Dr Thomas Ulmer MEP, Dr. Geseine Klein, President of ECHAMP, Dr Laurence Girod, Chair of the Heads of Agencies Homeopathic Medicinal Products Working Group (HMPWG) and Mr Tapani Piha for the European Commission DGSANCO. Following the presentations a number of interventions were made by members of the invited audience. ECCH General Secretary Stephen Gordon
called on the Commission to support the work of the HMPWG which has the difficult task of bringing a harmonised approach to homeopathic medicines by all countries in Europe with insufficient resources to to the job properly.
The report entitled 'The Availability of Homeopathic and Anthroposophic Medicinal Products in the EU' concludes that:Demand
: There is significant to high demand for homeopathic and anthroposophic medicinal products in at
least two thirds of EU Member States, and this applies to countries both with and without a long term tradition for these products.Availability
: Availability of registered/authorised homeopathic and anthroposophic medicinal products in the EU is insufficient and the demand cannot always be met. The types of products most widely available in pharmacies are those requested for self-medication.European legislation
: Implementation and enforcement of European medicines legislation for this sector has been slow and is very incomplete even twenty years after its adoption. Divergent implementation, interpretation and enforcement policy in the Member States make it extremely difficult for companies to operate across Europe.Regulatory environment
: The regulatory environment, including assessment capacity and policy at national level, is not proportionate to the large range of stocks and multiple finished medicinal products produced from these stocks, which are used in homeopathic and anthroposophic therapy. In many Member States the number of registered products poorly reflects the high numbers of homeopathic prescribers.Sustainability
: Availability is threatened in some Member States by the lack of a registration process, and in others by an incomplete process for the renewal of existing registrations. The regulatory burden is such that it is not sustainable to maintain registrations for the full range of medicinal products required for proper practice of these therapies.
1 November 2013
Integrating homeopathy and other complementary approaches improves cancer patients' care
A recent service evaluation study published in the Nursing Times shows that incorporating homeopathy and other forms of complementary care into the care of patients with cancer significantly improves outcomes and the quality of care: The authors conclude: Based on the current data, we propose that complementary therapy interventions make a significant positive difference, regardless of gender, age or patient/carer status. Further studies should be conducted by researchers independent of complementary therapy professions.
A full version of the article is available here: effects-of-complementary-therapies-in-cancer-care_161013.pdf
17 September 2013
Portuguese Government Shows Belgian Government The Error of Its Reactionary Way
On the 2 September 2013 the Health Minister of the Portuguese Government, Paulo Macedo, introduced the enacting legislation that lays down the future legal framework for the regulation of the practice homeopathy and 6 other CAM disciplines in Portugal. Lei 71/2013 is the product of a long process extending over a number of years and clearly sets out the requirements in terms of education and regulation for practitioners of CAM disciplines who do not have a conventional medical training but who wish to practise their discipline competently and responsibly.
The law establishes a framework that will facilitate the regulated growth of 7 new healthcare professions that will make a valuable contribution to the future healthcare of Portugal's people. Given the current crisis in healthcare precipitated by the failure of whole categories of medicines such as antibiotics, hospital systems under severe strain and the growing burden of chronic disease in an aging population, these new professions will have an increasingly relevant role to play in helping maintain health and treating ill-health effectively in the future.
The new Portuguese law stands in direct contrast to the way the Belgian Minister of Public Health, Ms Laurette Onkelinx has acted in this regulatory arena. In 1999 a perfectly good law, known as the Collas Law, was introduced onto the Belgian statute books aimed at establishing the regulation of homeopathy and three other disciplines by practitioners in a very similar way to that now achieved by the Portuguese Government. Unfortunately, after a long period in limbo, the law has latterly been through a highly questionable consultation process that has resulted in a perversion the original intention of the law.
After much lobbying by the Belgian homeopathic doctors the Collas law now defines homeopathy as a 'medical act' and restricts its practice to doctors, dentists and midwives. As a result homeopaths who currently practise in Belgium will now have to stop practising and non-one else can train in the future to be a homeopath in Belgium. Clearly, while Portugal promotes the future healthcare of its people, Belgium simply protects a small minority of doctors' interests. lei_n._71-2013_tnc.pdf
NB The wording of the new Portuguese law begins at the bottom right of the first page. An approximate English translation is available here: port - eng law.pdf
30 June 2013
Complementary and Alternative Medicine – an emerging
resource for EU healthcare systems?
There is agreement the EU
facing a growing health crisis. An aging population, rising levels of chronic
diseases such as cancer, diabetes and heart disease, mental ill-health and anti-microbial
resistance are all accentuated by the pressure of austerity on health systems. The
situation begs the question as to whether there are other ways to approach
healthcare that may be beneficial. In this context a conference entitled
‘Complementary and Alternative Medicine (CAM): An investment in Health ‘ took
place in the European Parliament on 27 June 2103.
Jointly organised by two
European Parliament interest groups – MEPS against Cancer and MEPS for CAM, the
conference was co-hosted and chaired by Alojz Peterle MEP (Slovenia), himself a
beneficiary of CAM treatment for cancer, and Sirpa Pietikäinen MEP (Finland).
DGSANCO Commissioner Tonio Borg in his opening keynote speech stated: ‘It is an important principle of the Union's pharmaceutical legislation
that patients should have access to the medicinal products of their choice.
This includes innovative medicines as much as traditional herbal and
homeopathic medicinal products….Patient empowerment is on the
increase. It progressively serves to put patients in the driver's seat – taking
charge and control of their own health. Patients often know what treatment
works for them, and which healthcare is efficient for their condition. This can
include the use of complementary medicine.’
The conference heard presentations from expert providers and researchers
covering the growing popularity of CAM with citizens, what characterizes CAM’s
holistic approach to patient care, the current provision of CAM in the EU and
the potential benefits of greater integration into health systems.
The conference heard there is little coherence in the way member states regulate the estimated
450,000 medical doctors, practitioners and other health professionals
practising CAM in the EU. Furthermore, member states’ variable implementation
of EU directives for herbal and homeopathic medicinal products is impacting
negatively on access by citizens and CAM providers.
Yet recent studies on the economics of CAM seem to indicate its
widespread use and integration could result on cost-savings for health systems.
One study that involved ‘mining’ the large data-base of Dutch health insurers
(1) , appears to show that patients of GPs who use CAM live longer healthier
lives and yet cost less in overall care. Evidence for effectiveness and
cost-saving was also presented from the pioneering health service in the
Tuscany Region in Italy (2) where the widespread integration of CAM across
hospital-based healthcare services is having positive impact on patient care
and costs. The Tuscany Region is actively involved in the EU European
Partnership for Action Against Cancer (EPAAC) and brings the contribution of CAM in the complementary care
of cancer patients to the project discussion table.
In closing MEPs Peterle and Pietikäinen called for the potential
contribution of CAM to healthcare in the EU to be taken more seriously by the Commission
and member states. They called for the EU to invest more in researching the
effectiveness and cost-effectiveness of CAM and to take action to resolve the
highly confused and inhibiting regulatory situation that currently exists for products,
providers and patients.
1) Patients whose GP knows complementary medicine tend to have lower costs and live longer
Kooreman, Peter; Baars, Erik W.
European Journal of Health Economics, Volume 13,
issue 6 (December 2012), p. 769 - 776.
22 April 2013
International Journal of Clinical Practice (IJCP) lowers standards - Part 2
We have been informed by the authors Tournier et al that the full text of their critical letter of response to the original article is now available in pdf from the following link:
http://onlinelibrary.wiley.com/doi/10.1111/ijcp.12138/abstract15 April 2013International Journal of Clinical Practice (IJCP) lowers standards
It seems when it comes to homeopathy established journals are ready to lower standards in order to publish negative research information about it - when it comes to positive research articles about homeopathy they are peculiarly resistant to publication at all. e.g. an astounding piece of epidemiological research showing the successful use of a homeopathic preparation in the prevention of seasonally epidemic leptospirosis in a population of 2.5 million in Cuba was refused publication in standard journals and was eventually published in 'Homeopathy' http://www.ncbi.nlm.nih.gov/pubmed/20674839
The International Journal of Clinical Practice has, in our view, lowered the standards of peer-reviewed scientific journalism with the publication of "Adverse effects of homeopathy: a systematic review of published case reports and case series' by Posadzki, I Alotaibi and E. Ernst in November 2013. http://onlinelibrary.wiley.com/doi/10.1111/ijcp.12026/abstract
The article was provided 'open access' enabling it to be as widely distributed and read as possible. To be blunt, in our view the article is an extremely poor piece of academic research work and it is difficult to understand how it got through the peer-review process of the IJCP - unless there were no peer-reviewers with an academic background in homeopathy involved in the review and/or the editor took a 'publish and be damned' attitude.
Along with a number of other authors, ECCH wrote to the IJCP raising a number of concerns about the content of the review. (As the IJCP chose not to publish it, our letter is appended at the end of this editorial). ECCH's letter briefly summarised a number of criticisms that other reviewers have raised in far greater detail. Two of these,including a joint letter from Viksveen, Roberts and Tournier of the Homoepathy Research Institute, have been now published by the IJCP. http://onlinelibrary.wiley.com/doi/10.1111/ijcp.12156/abstract.
Sadly however, while the original article has been widely disseminated through 'open access' the replies have not been made 'open access'.
Despite calls to do so, the editor has refused to retract the original article, but instead invites further discussion. In our view at the very least the critical responses should be made as available through 'open access'. To restrict access to these responses to journal subscribers only makes the editor's call for further debate on this poor quality paper seem highly disingenuous.
In the interests of 'open debate' and 'open access', ECCH's letter of response is attached here: ecch - posadski et al ijcp dec 2012.pdf
19 February 2013
Homeopathic Treatment of Migraine in Children: Prospective, Multi-centre, Observational Study shows positive results
3 December 2012
Objectives: The study objective was to evaluate the effectiveness of
homeopathic medicines for the prevention and treatment of migraine in
Design: This was an observational, prospective, open, non-randomized, non-comparative, multi-center study.
Setting/location: The study was conducted in 12 countries worldwide.
Subjects: Fifty-nine (59) physicians trained in the prescription of
homeopathic medicines and 168 children, aged 5–15 years, with definite
or probable migraine diagnosed using International Headache Society 2004
criteria were the subjects in this study.
Interventions: Physicians were given complete freedom in terms of
treatment prescription; thus, prescriptions were individualized for each
Outcome measures: The frequency, intensity, and duration of migraine
attacks in the 3 months prior to inclusion were compared with those
during the 3-month follow-up period. Pertinent data were collected using
questionnaires completed by the doctor and the patient or his/her
parent/guardian. The secondary outcome measure was the impact of
homeopathic medicines on education, measured as absence from school.
Results: The frequency, severity, and duration of migraine attacks
decreased significantly during the 3-month follow-up period (all
p<0.001). Preventive treatment during this time consisted of
homeopathic medicines in 98% of cases (mean=2.6 medicines/patient).
Children spent significantly less time off school during follow-up than
before inclusion (2.0 versus 5.5 days, respectively; p<0.001). The
most common preventive medicines used were Ignatia amara (25%; mainly
9C), Lycopodium clavatum (22%), Natrum muriaticum (21%), Gelsemium
(20%), and Pulsatilla (12%; mainly 15C). Homeopathy alone was used for
the treatment of migraine attacks in 38% of cases. The most commonly
used medicines were Belladonna (32%; mainly 9C), Ignatia amara (11%;
mainly 15C), Iris versicolor (10%; mainly 9C), Kalium phosphoricum (10%;
mainly 9C), and Gelsemium (9%; mainly 15C and 30C).
Conclusions: The results of this study demonstrate the interest of
homeopathic medicines for the prevention and treatment of migraine
attacks in children. A significant decrease in the frequency, severity,
and duration of migraine attacks was observed and, consequently, reduced
absenteeism from school.
The Journal of Alternative and Complementary Medicine. February 2013, 19(2): 119-123. doi:10.1089/acm.2011.0821.
Three Year EU CAMbrella Project Holds Final Conference in Brussels
After almost three years of planning, research, consultation and writing,
the 1.5 million Euro CAMbrella research project, funded under the EU Commission's FP7 research programme, held its final conference in Brussels on 29 November 2012. Held in the impressive surroundings of the Bavarian Representation right next door to the European Parliament, the final conference brought together an audience of 150 guests and interested parties to hear short reports from the various work package leaders on the findings and recommendations of each area of research.
Short summarising reports were given based on the themes of the 8 work packages: Terminology, Legal Status, Citizens’ Needs, Patients’ Perspective, Providers’ Perspective, Global Perspective, Research Roadmap and Communications. The reports are all being presented to the Commission for verification and should hopefully all be ready for public dissemination very soon.
For more information
11 October 2012Landmark conference on CAM takes place in the European Parliament
On 9 October 2012 an all day conference entitled ' Complementary and Alternative
Medicine - Innovation and Added Value for European Healthcare ' took place in the European Parliament Buildings in the heart of Brussels. Sponsored by three progressive MEPs, Oena Antonescu, Sirpa Pietikäinen and Alojz Peterle the conference speakers presented a very clear rationale for why CAM should become more integrated into EU member state healthcare systems in the near future. ECCH, together with other participants in the stakeholder group EUROCAM, played an active role in preparing, funding and running this conference.
30 September 2012Emerging evidence for the cost-effectiveness of complementary therapies and integrative care
A short report containing the conference declaration and a list of speakers with access to copies of their presentations is available here:http://epha.org/a/5387
A pdf of the special report produced for the conference 'Complementary and Alternative Medicine - current status and potential in European Healthcare'
is available here: eu cam booklet.pdf
In a comprehensive systematic review of economic evaluations of CIM aimed
at evaluating them for future health reform, 338 economic evaluations were identified of which 204, covering a wide of CIM for different populations, were published between 2001-2010. The review identified many evaluations previously missed by previous reviews and is without doubt the most comprehensive review of its kind ever undertaken. It identified emerging evidence of cost-effectiveness and possible cost savings in at least a few clinical populations. The authors conclude that more better quality studies are needed in this important area.
Are complementary therapies and integrative medicine cost-effective? a systematic review of economic evaluations
Patricia M Herman, Beth L Poindexter, Claudia M Witt, David M Eisenberg
BMJ Open 2012;2:e001046 doi:10.1136/bmjopen-2012-001046
The abstract and full article can be accessed here: http://bmjopen.bmj.com/content/2/5/e001046.abstract
NOTE: this paper would seem to add to the evidence outlined in a previous paper by Kooreman and Baars published in 2011 in The European Journal of Health Economics entitled "Patients who GP knows Complementary Medicine tend to have lower costs and live longer.
Here a data-set from a Dutch health insurer was used containing quarterly
information on healthcare costs (care by general practitioner (GP),
hospital care, pharmaceutical care, and paramedic care), dates of birth
and death, gender and 6-digit postcode of all approximately 150,000
insurees, for the years 2006–2009. Data from 1913 conventional GPs were
compared with data from 79 GPs with additional CAM training in
acupuncture (25), homeopathy (28), and anthroposophic medicine (26).
They found that patients whose GP has
additional CAM training have 0–30% lower healthcare costs and mortality
rates, depending on age groups and type of CAM. The lower costs result
from fewer hospital stays and fewer prescription drugs.