A major review of homeopathy in Australia could lead to stricter industry regulation and changes to private health insurance coverage.
(Transcript from World News Radio)
A major review of homeopathy in Australia could lead to stricter industry regulation and changes to private health insurance coverage of homeopathic treatments.
The investigation by Australia's top health research body, the National Health and Medical Research Council, has found no reliable scientific evidence to support claims that homeopathic remedies are effective in treating medical conditions.
Kristina Kukolja reports.
The philosophy of homeopathy can be traced back to the late 18th Century and a German physician, Christian Hahnemann.
He advanced the principle of 'like cures like', with diluted solutions used to treat symptoms that in an undiluted form they would cause.
Remedies can be sourced from mineral, herbal, animal and synthetic origins.
In Australia, homeopathy is classified as a form of complementary and alternative medicine, as are the chiropractic profession, Chinese medicine, yoga and pilates.
The first systematic review of homeopathy in Australia by the National Health and Research Council concludes there's no reliable scientific evidence of the efficacy of homeopathy in the treatment of clinical conditions.
The Australian Homeopathic Association disagreed with the findings, saying relevant systematic research it submitted wasn't considered.
Spokeswoman Anna Lamaro says some of the Association's other submissions were also overlooked.
"The veterinary studies with homeopathic medicine, 56 of which were strongly supportive of the efficacy of homeopathy. Neither did they look at the laboratory studies. Both the veterinary studies and the lab studies are great because they are placebo-free zones, really. And the evidence is strongly there that there is an effect gained on a physiological level from homeopathic dilutions. They also chose not to look at observational studies. Now, that is the lowest level of evidence. However, there are very large observational studies from homeopathic outpatient hospitals in Europe and the United Kingdom."
The NHMRC considered 57 systematic reviews of homeopathic treatments in humans relating to 68 conditions -- ranging from irritable bowel syndrome, migraine headaches, depression, through to HIV.
For a majority of them, the results of controlled clinical trials were examined.
It says many of the available primary studies it encountered were poorly designed, conducted and reported.
President of the Australian Medical Association, Steve Hambleton, says not all research is admissible.
"Observational studies might be a reason to do a proper study and not actually to conclude that something is cause and effect. What you really want to do is actually look, in particular, at the double-blind randomised control trials where you truly get rid of bias and you can truly test something against the placebo to see whether there is any difference to placebo treatment. That's where the NHMRC has gone. We hear lots of testimonials which peoples say, I tried it and it works for me. Sometimes there's a string of testimonials none of which are credible scientific evidence. When we look at animal studies, just because it works in a rat or another non-human animal doesn't necessarily mean it'll work in a human."
The World Health Organization has recognised homeopathy as one of the fastest-growing complementary and alternative medicines around the world.
But it cautions that some materials used in homeopathic formulations could constitute potential safety hazards.
It also warns that homeopathic solutions should not be used to treat serious diseases, including H-I-V and malaria.
In 2010, the British House of Commons Science and Technology Committee found that homeopathic remedies were no more effective than a placebo, and urged the National Health Service to stop funding homeopathy.
Bond University's Professor Paul Glasziou is the Chair of the federal government's Homeopathy Working Committee, which conducted the Australian investigation.
He says there's concern some people may be replacing proven medical treatments with homeopathic ones, meaning that they're not getting the appropriate health care they need and are also wasting their money.
"Speaking to general practitioner colleagues, I know of their concern about patients who are on the poverty borderline, but who are spending money for -- for example -- disabled children on homeopathic remedies. So, they're spending parts of the little amounts of cash that they have to purchase these remedies which appear to be ineffective."
The Australian Homeopathic Association says there are up to 600 practitioners in Australia registered with the Australian Register of Homeopaths, an industry self-regulation body.
It says more are practising, and around one-million Australians are estimated to be consumers of homeopathic treatments.
But Professor Paul Glasziou says the true extent of the industry in Australia is not actually known.
"This is what triggered this particular report as part of a wider concern that the NHMRC had about the increase in alternative and complementary medicine. I think it's now up to around $3.5 billion a year across the whole industry being spent. There are some effective complementary medicines, but in general a lot of things both in orthodox medicine and in complementary medicine don't work. In orthodox medicine there are routine research approaches and regulations that sift out these ineffective approaches, whereas that hasn't happened to anywhere near the same extent in complementary and alternative medicines."
Dr Jing Jing Yu is a Chinese medicine practitioner based in Melbourne, who has also practised in China.
Dr Jing has a Bachelor of Applied Science in Chinese Medicine and Human Biology.
Like medical and dental practitioners, pharmacists, nurses and psychologists, she is regulated by the federal government's Australian Health Practitioner Regulation Agency.
In order to retain her accreditation as a health practitioner, Dr Jing must belong to a recognised association -- in her case the Federation of Chinese Medicine Associations -- and undergo continued professional development.
These statutory standards are not required for practising homeopathy in Australia.
Dr Jing argues that Chinese medicine is more credible than homeopathy.
"Chinese medicine, from what I believe, there's a lot more credibility. If you go to China, for example, it is part of mainstream healthcare. There are a lot of herbs that can benefit a lot of conditions; but having said that it is always about the patients' health status. Everything is prescribed according to what the patient needs at that certain time. From what I understand, especially in the field of acupuncture, there's been a lot of scientific evidence that proves a lot of effectiveness in treating pain and a lot of other chronic illnesses."
Professor Paul Glasziou agrees that some Chinese medicine has been shown to be effective, but he says alternative medicines don't undergo rigorous testing.
"Taking the Chinese herbs would be Artemisinin, which is now widely used in malaria treatment and has been shown in controlled trials to be effective, and is on the World Health Organization's list of things to use. There are things we've got out of herbs in the past. Digoxin came out of foxglove, for example, and quinine is another example of something that's grown out of herbal medicine. But I would say, by and large, most things don't work and we need to screen out and evaluate all of these things to find out the small proportion that do and keep them in our therapeutic armamentarium."
Chinese medicinal products are regulated by the Therapeutic Goods Administration.
That's not necessarily the case for all homeopathic preparations.
The AMA's Steve Hambleton says the homeopathy industry in Australia is inadequately regulated.
"Unconventional therapies are very poorly regulated in reality. We have health practitioners now fully registered. Chinese medicine practitioners are now fully registered. There are minimum standards to be reached. There is a board whose job it is to protect the public from registered health practitioners who don't do what the wider body of the profession believes is reasonable. The unregulated industries are very broad. We've got multiple forms of unconventional therapy for which there is very little credible evidence. Unless they're making outrageous claims those industries are clearly very successful."
Professor Paul Glasziou agrees that stricter regulation of the homeopathy industry is needed, both for practitioners and the labelling of products they promote.
He also says private health insurance companies should make changes to their policies that offer reimbursement for homeopathic treatments.
"Let's start with the private health insurers. I think, either removing them or making it easier for people to have options that don't include ineffective treatments would be a good thing for both them and the consumers of that private health insurance. I would like to see the evaluation that the NHMRC has done for homeopathy extended to other areas of complementary and alternative medicine. I'd like consumers, in particular, to be a little more wary and sceptical of claims about complementary and alternative medicines, and in particular from this review, the impact of traditional homeopathy."
The NHMRC is calling for public submissions to the draft information paper on the efficacy of homeopathy.
Submissions close on May 26.
More information: http://consultations.nhmrc.gov.au/public_consultations/homeopathy_health