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NHMRC Draft Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions submission

ID: 
57
This submission reflects the views of
Organisation Name: 
Australian Homoeopathic Association Inc.
Please identify the best term to describe the Organisation: 
Legal association / organisation
Personal Details
Questions
Q1. Is the draft Information Paper presented and written in a manner that is easy to understand?: 

 

LEGEND:

Italics = quotes of draft report text

Underlined = suggested text additions by AHA

Normal text = AHA comments

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Page 4, footnote 1:

‘Since 2000, NHMRC has provided more than $86 million in funding for scientific research into complementary medicine and alternative therapies.’

This is not easy to understand because it is misleading. This sentence, within a report about homeopathy, implies that this considerable financial commitment of $86 million has a direct relevance to the topic under discussion – homeopathy. It leads the reader to believe that a significant part of the $86 million must have been invested in homeopathy research. Also, to be easy to understand, statistics need the right context, so this figure needs to be presented alongside the total NHMRC research-funding budget. To make the meaning of this point easy to understand, we therefore recommend that it be amended as follows:

‘Since 2000, from a total research budget of $ x million, the NHMRC has provided more than $86 million in funding for scientific research into complementary medicine and alternative therapies, of which $ x million funded research into homeopathy.’

 

Page 5, para 3, bullet point 4:

  • 'there are enough participants to be reasonably confident that, if there is a bigger change in the health condition in one group, this is not just due to chance'

This is not easy to understand as it incorrectly implies that smaller trials can never exclude chance (false positive results). As part of the NHMRC’s efforts to explain ‘reliable evidence’ to the public, it needs to be explained that smaller trials can also generate reliable results. Researchers know that the larger the trial, the more likely one is to detect a clinical effect (and for the results to reach statistical significance), so in fact, if a clinical effect is detected in a small trial with statistically significant results, this is actually a more impressive result. To explain this concept simply to the general public, we recommend that this bullet point be expanded as follows:

  • 'There are enough participants to be reasonably confident that, if there is a bigger change in the health condition in one group, this is not just due to chance. However if statistical analysis shows that the result of a trial is ‘statistically significant’, this means that the effect of the treatment is likely to be real, not just due to chance, even with a small number of participants.'

 

Page 6, para 2:

NHMRC used a combination of three main sources of information about the effectiveness of homeopathy (Figure 1):

  • published systematic reviews (summarised in the overview report)(1)
  • information provided by homeopathy interest groups and the public (summarised in the review of submitted literature)(2)
  • Clinical practice guidelines and government reports on homeopathy published in other countries.’

This is not easy to understand because saying that the NHMRC ‘used’ two sources of information other than ‘published systematic reviews’, leads the reader to believe that information other than systematic reviews had some impact on the Information Paper. This is untrue. Looking at the ‘List of considered evidence’ it clearly states that all information about the effectiveness of homeopathy other than systematic reviews was excluded.

This section therefore needs to be amended to better articulate which sources of information were actually ‘used’; we recommend the following changes:

‘NHMRC used a combination of three main sources of information about the effectiveness of homeopathy in humans (Figure 1):

  • published systematic reviews we found ourselves by searching the literature (summarised in the overview report)(1)
  • published systematic reviews provided by homeopathy interest groups and the public (summarised in the review of submitted literature)(2)
  • Clinical practice guidelines and government reports on homeopathy published in other countries.’

‘All other types of information about the evidence for effectiveness, whether found by us or provided by homeopathy interest groups and the public, were excluded. These included:

  • Research testing homeopathy in laboratory experiments
  • Research by veterinary surgeons testing homeopathy for treatment of animals
  • Other types of research on humans that were not systematic reviews
  • Research published in languages other than English.’

 

Page 6, para 2:
‘The NHMRC’s assessment was guided by a committee of experts appointed in 2012 (see The Homeopathy Working Committee).’

This is not easy to understand as the reader would assume that the word ‘experts’ means the committee members are experts in the subject being reviewed, not experts in other subject areas. We therefore recommend that it is amended to:

‘The NHMRC’s assessment was guided by a committee, appointed in 2012, of experts in other medical disciplines or medical research; the members were a general practitioner, a rheumatologist, a neuroscientist, a consumer representative, a pharmacist, a conventional medical research scientist and the Australian Government Chief Medical Officer (see The Homeopathy Working Committee). No-one with any expertise in homeopathy or homeopathic research was included on the committee, despite a list of four suitable candidates being supplied to the NHMRC (ref. Letter to Cathy Connor of the NHMRC from the Australian Homoeopathic Association dated 18 August 2011).

 

Page 10, Overall finding:
‘NHMRC concludes that the assessment of the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered.’

This is difficult to understand, because it is misleading for the average reader. This statement – which actually says that you have concluded that there is an ‘absence of evidence’ – is very likely to be misinterpreted by the general public as a statement that you have found ‘evidence of absence’ of a clinical effect.

This is not just supposition – national and international media reactions to the draft Information Paper demonstrate that this misinterpretation is already taking place, for example:

  • The ABC report on 9 April 2014 lead with the headline, ‘Homeopathy: National Health and Medical Research Council says Australians 'wasting money' with the alternative therapy.’
  • An article in The Guardian newspaper in the UK on 8 April 2014 lead with the headline: ‘Homeopathy is bunk, study says’ and went on to say that ‘Homeopathy is no more effective than a placebo, according to an extensive study by a peak science body.’

  • The Scientist, in an online article dated 14 April 2014 also erroneously stated, ‘Government researchers conclude that homeopathic therapies do not work.’

None of these statements concur with the ‘Overall finding’ or the more detailed findings of the NHMRC report as described in the Information Paper. The NHMRC has not found that homeopathy is a waste of money; the NHMRC has not found that the whole of homeopathy, in all its many forms and with its many different medicines, is no better than placebo; and the NHMRC has certainly not concluded that homeopathic therapies do not work.

We are sure that scientists with integrity who have worked on this report for the NHMRC must be distressed to see their work so wildly misrepresented around the world. Fortunately this consultation process provides the perfect opportunity to rectify this problem, allowing the NHMRC to take action to prevent this problem in future by amending the ‘Overall finding’ of the Information Paper so that it is clearer and will not be misunderstood.

On pages 10-16 of the Information Paper, the NHMRC has made several important points that are not clearly reflected in the ‘Overall finding’ and this is probably the source of confusion i.e. the amount of high quality evidence available in the field is small; there are some positive studies, but these need to be repeated by independent teams for confirmation of their findings and/or repeated on a larger scale.

To make the ‘Overall finding’ easy to understand and beyond misinterpretation by the public, media and decision-makers, we strongly recommend that this conclusion be amended as follows:

‘NHMRC concludes that there is insufficient evidence from research in humans to show whether homeopathy is effective or not for treating most of the range of health conditions considered. Some studies showed homeopathic treatments to be effective for certain conditions. These need to be repeated by independent teams for confirmation of their findings. In other instances positive studies were too small so they would need to be repeated on a larger scale to confirm that the results are not due to chance.

Q2. Does the draft Information Paper clearly outline how the evidence was reviewed and interpreted by the Homeopathy Working Committee?: 

 

LEGEND:

Italics = quotes of draft report text

Underlined = suggested text additions by AHA

Normal text = AHA comments

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Page 6, ‘Overview of systematic reviews’, para 3:
‘For each health condition, the research group collated the findings of the systematic reviews and assessed the quality and reliability of the evidence….’

This does not clearly outline how the evidence was reviewed because the average reader will have no understanding from the description of the methodology given here (or anywhere else in the Information Paper) about the inherent risk of bias involved in carrying out a systematic review of systematic reviews.

The fact that two layers of interpretation of the findings by the original authors is involved is something which needs to be made clear here, along with details to explain how the NHMRC established that their reviewers were truly independent and un-biased. This is a crucial issue whenever a review is conducted, but in this instance it is particularly important when one considers that both the general public and the media are already aware that in early 2011, the following draft NHMRC position statement was released via the Australian Doctor:

“NHMRC’s position is that it is unethical for health practitioners to treat patients using homeopathy, for the reason that homeopathy (as a medicine or procedure) has been shown not to be efficacious.”

There will be justifiable concern that an organisation holding this opinion at the outset of the review process cannot be trusted to carry out the review in an unbiased manner. To ensure the credibility of the NHMRC’s findings, we recommend that this paragraph be amended as follows:

 

Page 6, ‘Overview of systematic reviews’, para 3:
‘For each health condition, the research group collated the findings of the systematic reviews and assessed the quality and reliability of the evidence. When a systematic review is carried out, it is very important that the researchers involved can be trusted to interpret the findings of the trials they are reviewing totally objectively, without introducing strong opinions of their own which could influence their findings (known as bias). In April 2011 the NHMRC’s position on Homeopathy – that we believed the practice of homeopathy to be unethical because our assessment of the available evidence had shown that it didn’t work – became known to the public. However we have ensured that this strong opinion held by the NHMRC did not influence how the reviewers we hired to review the evidence by [insert explanation as to how reviewer lack of bias was ensured]. This means that you can trust the NHMRC to have conducted this review without prejudice against homeopathy.’

 

Page 6, final para – page 7, first sentence:
‘Only the types of evidence that were included in the overview (prospective, controlled studies) were assessed in detail. For each study included, the researchers assessed its quality and the reliability of its results, and summarised the findings in the review of submitted literature.(2)
NHMRC and the Homeopathy Working Committee considered this evidence when preparing this information paper.’

This does not clearly outline how the evidence was reviewed as it does not make the average reader sufficiently aware of the degree of inclusion/exclusion criteria applied to the evidence. To be clear, we recommend the following amendments:

‘Only the types of evidence that were included in the overview (prospective, controlled studies published in English) were assessed in detail. For each study included, the researchers assessed its quality and the reliability of its results, and summarised the findings in the review of submitted literature.(2) All studies published in other languages (whether positive or negative) were excluded.
NHMRC and the Homeopathy Working Committee considered this evidence when preparing this information paper.’

 

Page 7, para 2:
‘Evidence-based guidelines and government reports

NHMRC looked for major reports by other government bodies. Two recent major government reports were identified…’

This is unclear as the reader is likely to believe that the findings of these two government reports were included in the Information Paper, when in fact they were both excluded (List of considered but excluded evidence, numbers 112 and 7 respectively). We therefore recommend that it be amended to say:

‘Evidence-based guidelines and government reports

NHMRC looked for major reports by other government bodies. Two recent major government reports were identified but excluded as not being relevant to this review:…’

 

Page 10, para 2:
‘[NHMRC has invited experts in evidence based medicine, clinical trials, and complementary medicines research to review this information paper, at the same time as the current public consultation process. All comments received will be collated and considered by the Homeopathy Working Committee.]’

The meaning of this paragraph is ambiguous and so it does not clearly outline how the NHMRC is reviewing. It implies that comments may lead to some changes in the draft Information Paper. If this is the case, it needs to be clear to the general public whether ‘consideration’ of external comments by the Homeopathy Working Committee actually leads to any amendments or not. If the paragraph means that comments will be ‘considered’ but not lead to any changes, that would need a different clarification. Depending on what the paragraph is meant to convey, we therefore recommend that it be amended to one of the following versions:

‘[NHMRC has invited experts in evidence based medicine, clinical trials, and complementary medicines research to review this information paper, at the same time as the current public consultation process. All comments received will be collated and considered by the Homeopathy Working Committee. On publication of the final information paper, the collated external comments and list of associated amendments will be made available to the public.]’

Or,

‘[NHMRC has invited experts in evidence based medicine, clinical trials, and complementary medicines research to review this information paper, at the same time as the current public consultation process. All comments received will be collated and considered by the Homeopathy Working Committee, but will not lead to changes in the final version of the information paper.]

 

Page 10, Overall finding:

‘There were no health conditions for which there was reliable evidence that homeopathy was effective. No good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than a substance with no effect on the health condition (placebo), or that homeopathy caused health improvements equal to those of another treatment.’

This is not a clear outline of how the evidence was reviewed because it inaccurately implies that,

  • all evidence was considered
  • all medical conditions were considered
  • no good quality small trials have statistically significant results (see Reilly et al.1986; Sinha et al. 2012).

and also fails to include the facts that,

  • there are good quality positive trials which have only been categorised as ‘unreliable’ on the basis that they have not yet been repeated by another research team e.g. Galphimia glauca for allergic rhinitis (Ernst 2011)
  • there are good quality positive trials which met the inclusion criteria but were excluded (e.g. Jacobs et al. 2003; Schneider et al. 2005, Wiesenauer & Lüdtke 1996)
  • the NHMRC chose to use an unprecedented and inappropriate approach when reviewing the evidence base for homeopathy i.e. the reviewers considered the results of all trials on all the various homeopathic treatments for one condition collectively. For example, in the case of childhood diarhoea, one trial demonstrated that a particular treatment (a non-individualised complex homeopathic medicine) was not effective (Jacobs et al. 2006) and this was considered to count directly against two studies which found that a completely different approach (individualised homeopathic treatment) was effective (Jacobs et al. 1994 and 2000). This does not make sense and is unheard of in conventional medical research which quite rightly asks the question, ‘Is treatment X effective for condition Y?’ not, ‘Is conventional medicine effective for condition Y when you combine all trial results on all medicines?’

The same process can been seen in the example of allergic rhinitis – the evidence demonstrated that the isopathic medicine Betula (made from Birch pollen) was not effective (Aabel, 2000), but the homeopathic medicine Galphimia glauca was effective (Ernst 2011, Homeopathic Galphimia glauca for hay fever: A systematic review of randomised clinical trials and a critique of a published meta-analysis). Why were these results not assessed and presented separately as one would with, say, trials of two completely different anti-histamine drugs for allergic rhinitis? It is essential that the NHMRC explain to the public, homeopathy stakeholders and decision-makers, why they chose to use this unusual approach and justify its scientific validity.

Without re-analysis of the evidence bearing in mind the multiple issues raised above, particularly separation of the findings into ‘treatment X for condition Y’, this paragraph would need to be amended to make the limitations of this review process clearer to the reader as follows:

For the 61 health conditions considered, if we consider only prospective, controlled trials, and if we discount all trials with less than 150 participants (even if they had positive statistically significant results) and if we discount positive trials that have not yet been repeated by other teams of researchers, and if we do not consider positive trials which were accidentally excluded, and if we then combine all trial results for each condition, we can say that there was no reliable evidence demonstrating that homeopathy was effective.’

Although this is clearer from the point of providing the reader with an accurate account of the way the evidence was reviewed (Q2), it would not be easily understood (Q1). During the process of moving from this draft version to the final version of the Information Paper it is therefore necessary for the NHMRC to,

  • re-phrase the research question so that the evidence is assessed according to the usual research approach i.e. “Is there any evidence that treatment X is effective for condition Y?
  • re-analyse the evidence for conditions where it has been brought to their attention that there are positive studies with less than 150 participants, but statistically significant results such as allergic rhinitis (e.g. Reilly et al. 1986) and otitis media (e.g. Sinha et al. 2012 – a trial which showed there was no significant difference between conventional treatment and homeopathic treatment (p=0.247))
  • re-analyse conditions for which evidence was inaccurately excluded e.g. allergic rhinitis (Wiesenauer & Lüdtke 1996), childhood diarrhea (Jacobs et al. 2003), acute otitis media (Sinha et al. 2012) and vertigo (Schneider et al. 2005)
  • provide the reader with a list of specific treatments for which there is evidence of effectiveness in one trial or multiple trials by a single team, including the proviso that the results need to be confirmed by repetition in multiple trials or by other independent teams before being widely recommended (e.g. homeopathic Galphimia glauca for allergic rhinitis; isopathic Pollen for allergic rhinitis; individualised homeopathic treatment for childhood diarrhoea; individualised homeopathic treatment for otitis media; Vertigoheel for vertigo).

 

Page 10, Overall findings, bullet points:

  • ‘For some health conditions, homeopathy was found to be not more effective than placebo.
  • For other health conditions, some studies reported that homeopathy was more effective than placebo, or as effective as another treatment, but those studies were not reliable.
  • For the remaining health conditions it was not possible to make any conclusion about whether homeopathy was effective or not, because there was not enough evidence.’

The section above does not clearly describe how evidence was reviewed because the reader will not understand that the term ‘homeopathy’ has been used to mean all different homeopathic treatments considered together. As stated above (p.16, para 1), the only valid way to clearly present the findings of this review is by treatment, then condition.

It is also unclear that these findings, according to the NHMRC review, are based on unreliable evidence (page 11, para 6: Findings of the NHMRC Overview:‘ The quality of the evidence was generally low, so it was not possible to be confident that the evidence was reliable’).

For clarity we therefore recommend that these points be amended as follows:

  • Some homeopathic treatments for some health conditions were found to be not more effective than placebo, but the quality of evidence was generally low, so it was not possible to be confident that the evidence was reliable.
  • For other health conditions, some studies reported that some homeopathic treatments were more effective 
than placebo, or as effective as another treatment, but the quality of evidence was generally low, so it was not possible to be confident that the evidence was reliable.
  • For some health conditions it was not possible to make any conclusion about whether any homeopathic treatments were effective or not, because there was not enough evidence.’

 

Page 11, para 4:
‘For each health condition, all the available evidence was grouped together to form a body of evidence on that condition. A body of evidence was considered more reliable if it included studies that were high quality, well designed and with enough participants to make its results meaningful. A body of evidence was considered less reliable if there were very few studies, or if the studies were poor quality, badly designed, or included too few participants.’

Unless the NHMRC adjusts its analysis so as to assess individual treatments separately, this paragraph would need to be amended to give a clear description of how the evidence was reviewed i.e.:

For each health condition, all the available evidence was grouped together to form a body of evidence on that condition. Normally, trials on different treatments would then be looked at separately (so the evidence can show us which treatments do and don’t work), but instead of doing this, all trials on all different medicines and treatments were grouped together and analysed as a whole. This is not usually done in medical research because the results cannot be used to say which treatments work and which do not, but the NHMRC chose to do this because xxxxxxx [insert justification]. A body of evidence was considered more reliable if it included studies that were high quality, well designed and with enough participants to make its results meaningful. A body of evidence was considered less reliable if there were very few studies, or if the studies were poor quality, badly designed, or included too few participants and had not reached statistically significant results.’

 

Page 10, final sentence - page 11, bullet point 4:
‘…NHMRC took a range of factors into account when considering
the evidence in the systematic reviews: [….]
- whether studies included enough participants to provide meaningful results…’

It is unclear to the reader how the evidence was reviewed in this respect. Only by reading the Overview Report can one discover that the definition of ‘enough participants’ used in this review was 150. For the review process to be clearly described, this needs to be included in the Information Paper. Of even greater concern, no justification is given for this definition, even in the Overview Report. The public need to understand how and why this demarcation was made as it has a major impact on the NHMRC’s findings; for decision-makers the justification for the scientific validity of using n=150 as the definition of a sufficiently large study also needs to be provided, along with the rationale for dismissing statistically significant results in trials under n=150. We therefore recommend the following amendments:

 

Page 10, final sentence - page 11, bullet point 4:
‘…NHMRC took a range of factors into account when considering
the evidence in the systematic reviews: [….]
- whether studies included enough participants to provide meaningful results. The NHMRC decided that trials with 150 participants were large enough, whilst those with fewer participants were too small to be reliable. This number was not chosen at random, it was chosen because [insert NHMRC’s justification of scientific validity]. Trials with less than 150 participants which had statistically significant positive results (meaning that the trial showed homeopathy worked and this was unlikely to be due to chance) were discounted because [insert NHMRC’s reasoning].’

 

Page 12-13, Findings of the NHMRC Overview

                        The section ‘Findings of the NHMRC Overview’ is neither clear nor easy to understand for the reader; without going to the Overview Report and making significant effort, the reader cannot tell which conditions are in each of the following very important, discrete categories:

        ‘Homeopathy compared with placebo

        For 13 health conditions, homeopathy was reported to be not more effective than placebo.

        For 14 health conditions, some studies reported that homeopathy was more effective than placebo, but these studies were not reliable [....] they would need to be confirmed by other large, well-designed studies.(1)

        For 29 health conditions, only one study that compared homeopathy with placebo was found, and each of these studies was unreliable [....] For these conditions, it was not possible to make any conclusion about whether homeopathy was effective or not.

        Homeopathy compared with other treatments

        For 8 health conditions, some studies reported that homeopathy was as effective as another treatment, or more effective than another treatment, but these studies were not reliable. [....] they would need to be confirmed by other large, well-designed studies.

        For 7 health conditions, only one study that compared homeopathy with another treatment was found, and each of these studies was unreliable. [....] For these conditions, it was not possible to make any conclusion about whether homeopathy was effective or not.’

These findings by the NHMRC are extremely important and of interest to many people, so it is imperative that they are clearly understood. We therefore strongly recommend that, once the NHMRC has re-analysed the data by treatment and condition and adjusted the figures to reflect other external input, this section is made more specific as follows:

        ‘Homeopathy compared with placebo

        For X health conditions, the X homeopathic treatments tested were reported to be not more effective than placebo. These were: [Insert list of conditions and treatments]

        For X health conditions, some studies reported that homeopathy was more effective than placebo, but these studies would need to be confirmed by other large, well-designed studies before considering widespread use of the treatments tested(1) These included: [Insert list of conditions and treatments]

        For X health conditions, only one study that compared a homeopathic treatment with placebo was found, and each of these studies was unreliable [....] For these conditions, it was not possible to make any conclusion about whether homeopathy was effective or not. These included: [Insert list of conditions, treatments and reason for being ‘unreliable’]

        Homeopathy compared with other treatments

        For X health conditions, some studies reported that homeopathy was as effective as another treatment, or more effective than another treatment, but these studies would need to be confirmed by other large, well-designed studies before considering widespread use of the treatments tested (1) These included: [Insert list of conditions and treatments]

        For X health conditions, only one study that compared a homeopathic treatment with another treatment was found, and each of these studies was unreliable. [....] For these conditions, it was not possible to make any conclusion about whether homeopathy was effective or not.’ These included: [Insert list of conditions, treatments and reason for being ‘unreliable’]

Q3. Is there additional evidence on the effectiveness of homeopathy for the treatment of clinical conditions in humans that needs to be considered? To be considered in public consultation any additional evidence must:: 

 

LEGEND:

Italics = quotes of draft report text

Underlined = suggested text additions by AHA

Normal text = AHA comments

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The following new evidence should be considered before finalising the Information Paper:

            1. Jacobs et al, Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials, Pediatr Infect Dis J, 2003;22:229–34

         This study was excluded on the basis that it was a ‘non-systematic review’. However, Jacobs reviewed all published Level II primary studies on individualised homeopathy for childhood diarrhoea – her own RCTs – then carried out a meta-analysis. As this study is a legitimate systematic review, it fits the NHMRC’s inclusion criteria and now needs to be included.

            2. Schneider et al. Treatment of vertigo with a homeopathic complex remedy compared with usual treatments – a meta-analysis of clinical trials, Arzneim.-Forschung 2005, 55(1) 23-29.

         According to the Overview Report this review was excluded on the basis of being a ‘Level III-3 study’ (comparative study with no concurrent control). This is incorrect because it the study contains two Level II studies, in addition to the two Level III-3 studies. As this systematic review fits the NHMRC’s inclusion criteria, it was incorrectly excluded and now needs to be included.

            3. Sinha et al. Randomised controlled pilot study to compare Homeopathy and conventional therapy in Acute Otitis Media. Homeopathy 2012, 101: 5-12.

         This study was too recent to have been included in the systematic reviews on otitis media. It was not found by the NHMRC literature search and so was submitted to the NHMRC by an external party. The study was excluded on the basis that,

‘[…] this is a self-selected study and other literature concerning the effectiveness of homeopathy for otitis media has not been systematically retrieved.’

            This cannot be considered a legitimate reason for exclusion. Sinha et al. 2012 is good quality RCT on a condition for which a systematic review exists and therefore fits the inclusion criteria.

            It is unreasonable to down-grade the relevance of any study by categorising it as a ‘self-selected study’ simply because the NHMRC overlooked it. As for the second part of the reviewer’s justification for exclusion,

‘….and other literature concerning the effectiveness of homeopathy for otitis media has not been systematically retrieved.’

            This does not make sense. Optum did a full literature search on homeopathy for otitis media. When they were made aware of the existence of the Sinha et al. study, if they needed to establish that they had not missed any other recent studies which would influence their interpretation of the Sinha et al. study, surely with the vast resources of Optum at their disposal, they could have ‘systematically retrieved’ all papers dated 2012 onwards for this condition?

            When Sinha et al. is included in the Overview Report following this public consultation, it is essential that the NHMRC make it clear how their reviewer managed to reach such a vastly different conclusion from that of the original authors in this case: Sinha and colleagues concluded that individualised homeopathic treatment was as effective as conventional care:

There were no significant differences between groups in the main outcome. Symptomatic improvement was quicker in the homeopathy group and there was a large difference in antibiotic requirements favouring homeopathy”

whilst the NHMRC reviewer concluded the direct opposite i.e.

‘The addition of Sinha et al (2012) to the body of evidence for otitis media is consistent with the conclusion from the Overview Report that there is no reliable evidence that homeopathy is as effective as other therapies for the treatment of children with acute otitis media.’      

            4. Wiesenauer and Lüdtke. A meta analysis of the homeopathic treatment of pollinosis with Galphimia glauca. Forsch. Komplementärmed. 1996; 3: 230-234

         According to the document Review of Submitted Evidence (ref. 317), Wiesenauer & Lüdtke (1996) was excluded on the basis that the study was not published in the English language. This is incorrect as the article is in English. As this study fits the NHMRC’s inclusion criteria it was incorrectly excluded and now needs to be included.

Page reviewed: 11 March, 2015