Eminent neurologist Dr Raymond Schwartz said it well over dinner one night, “Evidence of itself doesn’t always mean that a remedy works, and conversely, lack of evidence doesn’t necessarily mean that a remedy doesn’t work.” He went on to explain that at present, the evidence behind the use of stem cells lacks evidence but that is likely to change over time.
The critics of homeopathy and complementary medicine have taken an interim report released by the National Health and Medical Research Council (NHMRC) today on the use of homeopathic remedies and raised questions about pharmacies stocking these products.
In my own experience as a Naturopath, I have mixed views on the use of homeopathic treatments. I can say that on a recent trip to Italy I was presented with a homeopathic remedy from a homeopathic pharmacy with good results.
However, I have serious concerns that the NHMRC review has not considered the necessary body of evidence to classify this longstanding traditional modality as ineffective and their interim ‘findings’ may have provided a platform for criticism from the skeptics of natural medicine to express their narrow views.
Those questioning the place for traditional medicines in pharmacy should be aware of the limitations of the NHMRC complementary therapy review:
As a ‘review of reviews’ was employed to gather information, the evaluation fails to include any randomised trials or studies that have not been captured by a review.
- Only papers published in the last five years were considered thereby excluding a lot of evidence.
- The review only included databases published in English which, considering many traditional modalities have their origin in Europe, excludes some of the most compelling data.
- The Homeopathy Working Committee has no homeopaths on its panel, though interestingly it did have a consumer advocate (would the NHMRC conduct an enquiry into psychology without having a psychologist on its panel?)
- The totality of evidence was not also assessed, for example laboratory or animal (vet) studies were excluded.
So, is it fair to say the ‘review’ itself is ‘evidence-based’?
Dr Lesley Braun, Director of Blackmores Institute, reminded me of the words of Sackett, widely considered the chief founding father of modern day evidence based medicine, “evidence based medicine is not “cookbook” medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients’ choice, it cannot result in slavish, cookbook approaches to individual patient care. External evidence can inform, but never replace, individual clinical expertise…” (Sackett et al. 1996).
No profession, modality or therapy can claim to be the most effective or safe, however it is the right of the 70% of Australian pharmacy customers taking OTC herbal or natural supplements to access the therapies in which they find benefit particularly when they are well-tolerated and cost-effective.
Notwithstanding, there are currently severe limitations to building a more comprehensive evidence base including:
- Lack of government funding into well-conducted research
- Perceived bias against privately-funded research
- Lack of private investment because of an inability to commercialise and IP-protect findings
- Debate over methodology that acknowledges the nature of traditional treatments
Hopefully in time, we can overcome these limitations. However in the meantime we must be cautious about making conclusions based on pseudoscience.
Dr Braun prudently observed that “making public health recommendations based on methodology shaped by inadequate resourcing rather than robust, good science isn’t very scientific at all.”
Read the NHMRC press release : http://www.nhmrc.gov.au/media/releases/2015/nhmrc-releases-statement-and-advice-homeopathy
Read Complementary Medicines Australia’s comments: http://www.cmaustralia.org.au/Resources/Documents/16%2012%2014_Fundamental_Flaws_of_the_NHMRC_Homeopathy_Review.pdf
Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B., & Richardson, W.S. 1996. Evidence based medicine: what it is and what it isn’t. BMJ, 312, (7023) 71-72 available from: PM:8555924