In the last few months, the Lancet article denouncing homeopathy as placebo evoked a lot of emotion in the homeopathic community. With time, more details about the study and the article have been brought to light and I am pleased to share those details with you.
Do you know that the Lancet-article was based on an isolated part of the Swiss PEK (Programms Evaluation Komplement /Program for Evaluating Complementary Medicine) studies? The PEK studies were organized and financed by Swiss government to get the scientific base for a decision concerning CAM (Complementary/Alternative Medicine). It turns out, that the results of the studies were too good (in favour of CAM) – so the politicians chose to completely ignore the PEK-study at the end …and came to a negative decision!
Here is the summary of the Swill PEK Report:
Following the decision taken by the Federal Department of Home Affairs (DHA) on 9 July 1998, five complementary therapies – anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine (more precisely, traditional
Chinese herbal therapy) – were included on 1 July 1999 for a limited period (until 30 June 2005) in the list of services covered by the compulsory health insurance scheme (KLV).These services are only eligible for reimbursement if they are provided by physicians who have the relevant proficiency certificates, issued by the Swiss Medical Association (FMH).
The decision on whether these complementary methods should be retained within the basic health insurance scheme is dependent on their efficacy, appropriateness and cost effectiveness being demonstrated. To this end, the Complementary Medicine Evaluation
Programme (PEK) was carried out from 1998 to 2005.
Design of the PEK:
A basic procedure was defined, comprising two parts. In Part 1 (evaluation of the provision of complementary medicine for patients in Switzerland), empirical studies were to be carried out, permitting conclusions as to:
(a) how prevalent the five therapies are in Switzerland,
(b) which physicians offer these therapies,
(c) which patients have recourse to them,
(d) what results are achieved with these treatments, and
(e) what impact these therapies have on costs.
For points b, c, and e, comparisons were made with conventional medicine. On account of methodological and time-related problems, however, point d could not be evaluated.
In Part 2 (literature analysis), the literature available internationally on efficacy, appropriateness (here primarily defined in terms of safety and utilization) and cost-effectiveness was to be systematically compiled and reviewed.
Results of the evaluation of the provision of complementary medicine for patients in Switzerland
In 2002, 10.6% of the Swiss population had recourse to at least one of the five complementary therapies, with homeopathy being the individual method most frequently mentioned (stress mine).
Practitioners of complementary medicine can be distinguished from physicians providing conventional healthcare with regard to the nature, location and technical resources of their practice. The patients they treat tend to be younger, female and better educated. These patients tend to have a favourable attitude towards complementary medicine and to exhibit chronic and more severe forms of disease. Technical diagnostic procedures are performed more rarely, and patients’ wishes are taken into account more frequently in the choice of treatment. On average, the consultation lasts markedly longer than in conventional care.
Patients are more satisfied with the care provided (stress mine) in practices offering complementary medicine.
Side effects are reported by markedly fewer patients (stress mine) than with conventional care – with the exception of phytotherapy.
With complementary medicine, the total annual costs are markedly lower than the average for conventional care (stress mine). Overall, however, complementary practitioners treat fewer patients, and more frequently younger and female patients. Adjusted for these factors, the total patient-related costs do not differ significantly from those for conventional care. The cost structure is characterized by a greater weighting for consultation costs and a lower weighting for drug costs. The actual increase in costs resulting from the inclusion of the five complementary therapies in Switzerland’s basic healthcare provision proved to be markedly lower than expected (stress mine). On the basis of the statistics produced by the PEK, the question of whether complementary medicine should be regarded as being utilized in addition to or, rather, instead of conventional care cannot be definitively answered.
Results of the literature analysis
The analysis of the literature involved two different projects.
(1) For each of the five complementary therapies, a comprehensive overall evaluation (evaluation report) was prepared.
(2) In addition, meta-analyses (systematic reviews including statistical evaluation of aggregated data) of placebo-controlled clinical studies were prepared for homeopathy, phytotherapy and traditional Chinese herbal therapy.
As regards the first project, the assessment of efficacy was favourable in all of the evaluation Reports (stress mine). For phytotherapy and homeopathy in particular, this was based on the evaluation of published systematic reviews and randomized clinical studies. In the case of traditional Chinese herbal therapy, while numerous randomized studies of Chinese origin exist, they are scarcely available in Western countries.
In the view of the evaluation committee, the interpretation of the available evidence on efficacy in the evaluation reports appears to be overly optimistic for all of the methods reviewed, and especially for neural therapy. The safety of all five therapies is favourably assessed (stress mine), with certain reservations in the case of neural therapy and traditional Chinese herbal therapy.
Data concerning utilization are only available for complementary medicine as a whole; for many countries, the uptake is shown to be high and still increasing (stress mine).
As regards the second project, in the view of the authors of the meta-analyses, the available placebo-controlled studies on homeopathy do not demonstrate any clear effect over and above placebo. For phytotherapy, in contrast, a positive result is shown, as in the evaluation report, and for traditional Chinese herbal therapy an unequivocal assessment is not possible. Here, too, the validity of the conclusions of the meta-analyses should be regarded as limited from a methodological perspective.
As fas as that meta-analysis is concerned, I have already shown in my previous article ‘Homeopathy, Research & The Lancet’ that the meta-analysis is biased and full of short comings. To read the full article, click here.
But this is not all. The whole phenomenon of setting up the PEK, and issuing of its report was highly political. If you want to find out the extent to which political setup and conventional medicine can go to hamper the growth of homeopathy and complementary medicine, read the following (not very well translated report) from an insider who was part of this whole PEK process:
This is in German. You can read an English version (machine translation) here –
More about this report from Dr Ton Nicolai, ECH, President
Decision of the Swiss authorities
Although homeopathy and other CAM therapies proved to be cost-effective and may save millions of Swiss Francs on the health budget, the Swiss government decided to exclude all CAM therapies from the compulsory health insurance scheme as from 30 June 2005, much to the dissatisfaction of the CAM.
The Swiss authorities – both the government and the National Health Office (BAG) – initially tried to sweep the results of the PEK study under the carpet. A conference scheduled for April 2005 to present and discuss the results of the PEK study had to be cancelled because the National Health Office suppressed the publication of the study data. Some collaborators were even coerced into deleting all PEK related data from their computers. A final meeting of the international Review Board of 6 professors from Switzerland, Germany, Denmark and the UK – responsible for the scientific quality of the PEK study – to be held in June 2005 for a final assessment of the project, was cancelled. The recommendation in the final draft that homeopathy, anthroposophical medicine and herbal medicine should stay in the compulsory health insurance scheme was deleted in the final publication (stress mine). Later on the government allowed some reports to be put onto the BAG website and the data files to be available for perusal at the BAG office in Bern.
The report by the SVHÄ concerning homeopathy, can be found at http://www.dzvhae.com/portal/pics/abschnitte/030605064159_antrag_svha.pdf
An initiative of the general public called “Yes to Complementary Medicine” has already been supported by 145,000 signatures. A survey of March 2005 revealed that 87% of the Swiss population wants CAM to remain reimbursed under the compulsory health insurance scheme and that 31% has seen a CAM doctor at least once in the past year. A member of the Swiss parliament has questioned the government about the issue.
The report on the PEK study (in German) can be downloaded at:
The statistical analysis of CAM utilization in Switzerland (also in German) can be found at:
At the homepage of the Swiss Homeopathic Doctors Association (http://www.svha.ch) several interesting articles can be found about the way the Swiss authorities (the government and the National Health Office) and the medical establishment have dealt with the results of the PEK study (most of them in German, some in French).
There is a critical commentary by the Review Board, which accompanied the PEK-process (Harald Walach as a member):
A report from the PEK-symposium with Walach, Linde etc. in Zurich, december 8th 2005: http://www.unipublic.unizh.ch/magazin/gesundheit/2005/1996.html
I request all of you to forward this letter to everyone you know, so that more and more people can find out about this conspiracy against homeopathy and alternative medicine. Let us raise our collective voice against such efforts to hamper the growth of homeopathy. Send me your feedback, opinion and views at firstname.lastname@example.org