Interview: Strange “expert opinion” on homeopathy

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Homeopathy: strange "advice" from the British House of Commons

"This is how lobby works": A committee of the British House of Commons has just come to the conclusion that homeopathic medicines are nothing more than a placebo. The “experts” urge the legislator to remove funds from the National Health Service (NHS) catalog of services and to refrain from further research. However, if you question the evaluation criteria and the way the “report” was drawn up, there are great doubts about the informative value. The document does not correctly reflect the state of international research and, in our opinion, represents the personal position of one person in the essential points: Prof. Edzard Ernst. The editorial team asked journalist Claus Fritzsche about his assessment.

Mr Fritzsche, the House of Commons Science and Technology Committee concluded in an opinion that homeopathic medicines were not effective and should therefore not be paid for or approved. How do you rate the quality of this report?

Claus Fritzsche: Against the background of many unanswered questions, I don't trust myself to make a final judgment at the moment. After a first diagonal scan of the 275-page document, it is clear to me that Evidence Check 2: Homeopathy incorrectly reflects the state of research on homeopathy and the background to its formation is not transparent.

The House of Commons Science and Technology Committee, I believe, is here Large theatre played ... leaves the question open, however, why the arguments of the public hearing, for example those of Prof. Harald Walach and Prof. George Lewith, were ignored without comment, while those of Prof. Edzard Ernst dominate the entire document.

There are many indications that the results of the “expert opinion” had already been determined before the public hearing and that Edzard Ernst had directed it in the background - not transparent to the public. In any case, the hearing was a pure alibi event.

Can you clarify that a bit?

Claus Fritzsche: As far as I can judge this at the moment, the entire argumentation of the "report" - I attach importance to the quotation marks - is mainly based on a single meta-analysis. On page 22 Prof. Edzard Ernst is quoted as follows:

"Professor Ernst pointed out that: ... 5. Shang et al very clearly arrived at a devastatingly negative overall conclusion."

This is that ominous job that the British medical magazine made The Lancet 2005 a little prematurely proclaimed the "end of homeopathy". And that's on the basis of no more than eight studies.

What exactly are you criticizing?

Claus Fritzsche: Mr. Ernst does not mention that the meta-analysis by Shang et al. 2005 were already refuted by control work by Lüdtke / Rutten in the Journal of Clinical Epidemiology and by Rutten / Stolper in the Journal Homeopathy. The flaws of the meta-analysis were so blatant that even the The Lancet publisher Elsevier felt compelled to publish the press release "New evidence for Homeopathy".

If Ernst does not even mention the control work by Lüdtke, Rutten and Stolper, then I rate this as a deliberate and malicious deception by the public. It is about as if Toyota did not disclose its current recall campaigns in a report on the quality of its vehicles.

Was there no review process for the British “report”?

Claus Fritzsche: This is a very good question. In any review process carried out according to international standards, the reference to Shang et al. 2005 was criticized without the simultaneous mention of Lüdtke, Rutten and Stolper. With such a coarse carver, it can be assumed that there was manipulation and flicking behind the scenes.

Who is responsible for the scientific expertise of the "report"?

Claus Fritzsche: That's the next exciting question I can't answer for you. The only thing that is certain is that the persons named on page four - responsible for the "report" - do not have the necessary scientific expertise. What is also certain is that the document does not give an account of who evaluated the results of the public hearing and according to which criteria and brought them into the final form. Who took certain arguments from the hearing and ignored other arguments? I would be very interested in an answer to this question.

Do you have a guess?

Claus Fritzsche: (laughs) After the document "felt" quotes Edzard Ernst at least thirty times on each page, the evaluation criteria correspond 1: 1 to the well-known personal opinion of Edzard Ernst ... and after the work also includes the typical mistakes of Edzard Ernst such as Answering this question is very easy for me, for example, by not mentioning Lüdtke, Rutten and Stolper, overestimating the criterion "plausibility" and uncritically prioritizing randomized clinical trials (which have great weaknesses as well as strengths).

I cannot tell you whether the “expert opinion” was written by himself or just covertly prompted. For me personally, however, it is certain that Edzard Ernst was the director here in the background - not transparent to the public.

In our preliminary talk, you mentioned a “competition” report on homeopathy published on behalf of the Swiss government. What exactly was examined here?

Claus Fritzsche: In 2005, the Swiss Federal Office of Public Health published a Health Technology Assessment report on homeopathy, which was prepared as part of the "Evaluation Evaluation Complementary Medicine" (PEK). The aim of the PEK was to scientifically evaluate five important methods of complementary medicine (anthroposophic medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine). The PEK consisted of a field study project and a literature project. Scientific support was provided by a steering committee, a group of experts and an international review board.

What are the differences between the "report" of the British House of Commons and the Swiss HTA report?

Claus Fritzsche: First of all, the Swiss took seven years. It took five years to review the data and clarify conceptual questions. The actual evaluation and preparation of the HTA report took two years.

Anyone attending the UK public hearing on Evidence Check 2: Homeopathy wanted to participate, he had exactly 17 days until the deadline. This is a clear indication of a circus event. A broad knowledge base should be suggested to the public, which in reality does not exist.

Who examined the data in Switzerland?

Claus Fritzsche: As part of the Swiss HTA, there was full transparency as to who evaluated data according to which criteria and why they reached which conclusions. All of this is unclear and intransparent in the British “expert opinion”. The second big difference is the fact that Switzerland used international expertise, but the British only nationally. And although even the British expertise represented by Edzard Ernst, George Lewith and Harald Walach (now working in Frankfurt an der Oder) would have been sufficient, the know-how of the latter experts was not taken into account without giving reasons.

Are there differences in the evaluation criteria?

Claus Fritzsche: There are differences here in that Switzerland was based on international standards and the British - I see that - resorted to Edzard Ernst's personal assessment.

What does that mean specifically?

Claus Fritzsche: Please allow me a little preliminary remark: As I explained some time ago in a blog post entitled "Doubtful Meta-Analyzes: How Evidence Is Evidence-Based Medicine?" Using three plastic examples, research results can be relatively easily divided into one of the respective Researchers “shape” the desired direction. By cleverly choosing the evaluation criteria, the same data situation - in the name of truth and science - can easily be "shaped" POSITIVE or NEGATIVE results.

Has the British "report" made use of this possibility?

Claus Fritzsche: It is exactly like that. The Swiss HTA did what is common internationally today. The study type suitable for a specific question was selected. If I want to know whether a therapy works under everyday conditions, randomized clinical trials (RCTs) are rather unsuitable as a measuring instrument because of their low external validity. Other types of studies such as Observational studies have a much higher external validity and are therefore used in health services research to enable statements to be made about the effect of a therapy under everyday conditions.

However, if I want to know what exactly works in a therapy, RCTs are the appropriate measuring instrument because of their high internal validity, and observational studies, good case series or longitudinal cohort studies are rather unsuitable measuring instruments. RCTs are well suited to measure specific and non-specific effects. Here, too, they have major weaknesses in addition to strengths. RCTs are overwhelmed with measuring specific effects when it comes to complex interventions. It is also controversial to what extent RCTs can be used to measure the effects of an individual dose - in classic homeopathy, every patient receives his own, person- and disease-specific medicine.

Within the framework of the Swiss HTA, as is customary internationally, a suitable measuring instrument was chosen for the respective question. In the "House of Commons" report, however, there is a one-sided prioritization of randomized clinical trials. This overestimation of the strengths of RCTs and undervaluation of the weaknesses of RCTs is no longer accepted internationally. It contradicts the perspective of important instances. The expert advisory council advising the German Federal Ministry of Health on the assessment of developments in health care and also the chairman of the National Institute of Health, Sir Michael Rawlins, consider the one-sided prioritization of RCTs to be wrong.

What is the effect of unilaterally prioritizing RCTs?

Claus Fritzsche: Experts such as Klaus Linde from the German Cochrane Center, Claudia Witt from the Berlin Charité or Rainer Lüdtke from the Karl and Veronica Carstens Foundation explain better than I do. Let me put it bluntly: A blanket preference for randomized clinical studies across all questions and ignoring the known weaknesses of RCTs is worthwhile in the present case if I want to “shape” the result at the expense of homeopathy.

This form of result manipulation is worthwhile in a political context, such as that in the UK, when competing experts are bombed out and mass media (not experts) are the only supervisory authority. The typical Feld-Wald-und-Miesen journalist cannot understand the connections explained here due to lack of know-how, time and often also lack of motivation. He tends to believe in experts and can easily be lulled by scientific-sounding terms.

At least that is my opinion.

What was the conclusion of the Swiss HTA report on homeopathy?

Claus Fritzsche: The conclusion of the Swiss HTA is:

“Taking into account internal and external validity criteria, the effectiveness of homeopathy can be regarded as proven, and its professional, appropriate use as safe. "
(Source: Researcher Complementary Medicine 2006; 13 (suppl 2): ​​19–29)

However, the Swiss HTA leaves open the question of why this is so. This question is still the subject of research such as the Homeopathic Pathogenetic Trials by Harald Walach et al., which I presented in my blog post “New study design proves specific effects”. The results of the controlled and blinded HAMP studies so far are spectacular and speak for specific effects of homeopathy. At the public hearing of the British House of Commons they were submitted in the form of a memorandum by Walach and Lewith ... but also ignored by that ominous Mr. X, the unknown director of the British "report", without reason. But who is surprised. This is how lobby works ... (laughs)

Mr. Fritzsche, thank you very much for this interview. (, 02.03.2010)

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