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Has Australia's Medical Research Council been caught producing highly problematic research to discredit homeopathy?
The message that homeopathy doesn't work has been hammered by the mainstream media and the medical industry. Even for those who are supporters of natural medicine, the message that homeopathic medicine is scientifically impossible seems to resound deeply. The notion that diluted and potentized medicine not only works, but is highly effective, appears preposterous at first glance, particularly in the light in which it is presented. Is homeopathy really unscientific? A deep dive into medical literature proves otherwise. There are a couple of studies, systematic literature reviews [i] which the medical industry and media have upheld as the basis for their narrative. This is the very important story of one of those studies.
A Systematic Review released five years ago by the National Health and Medicine Research Council of Australia (NHMRC) has been used globally to shape policy around homeopathic medicine. This study used a highly questioned methodology never seen before nor since in a systematic review[ii] (I will further discuss this below). The bias was so evident and profound, that a freedom of information request on this review led to the discovery that a high quality study with a more positive outlook for homeopathy had actually been buried. High intrigue and drama indeed!
Why is this important?
Homeopathy has been a polarizing medicine since its inception over 200 years ago by Samuel Hahnemann. Conventional medicine has been fighting homeopathy ever since, particularly in times when it was much more popular than allopathy.
Homeopathic medicines are cheap to produce, can't be patented, and are easy to replicate, thus it is seemingly impossible to achieve the staggering profit levels from homeopathic medicines that pharmaceutical companies are accustomed to earning today. Hence, the industrial medical complex sees homeopathy as a threat to its profits and continued existence. I would like to assert otherwise, that homeopathy, conventional medicine and other forms of traditional medicine can all co-inhabit the same space and enrich each other's effectiveness in the real world, but that is a topic for another article.
We have moved into an era where evidence-based medicine is considered the gold standard. But how can we move forward in health policy and appropriate treatments when the "evidence base" itself is biased, fraudulent and influenced by profits? While funding for research in Natural Medicine is almost non-existent.
The literature review produced by the NHMRC has been used not only in Australia, but also in the UK, Europe, and the United States, to shape public health policy and public opinion. A cursory search on the internet will show how many mainstream media outlets have covered the story of the report when it was released in 2015. Exalted news agencies - amongst them The Guardian, CBS and Time magazine - all misrepresented the results with the incorrect conclusion that homeopathy does not work for any condition. The NHMRC is a highly recognized authority on which health practitioners, policy makers, and researchers rely. So what do we do when our public institutions, created to uphold truth, can no longer be relied on?
What is wrong with the NHMRC review?
The review claims to have looked at 1800 studies, but in fact they only considered 176, of which only 5 matched their unprecedented quality thresholds, based on the number of participants in a study. They only looked at studies that had more than 150 participants. While this may sound reasonable at first, it in fact has nothing to do with the NHMRC's standards for other trials, and this minimum set sample size has never been used before, or since, as it has no scientific basis[iii]. Other NHMRC-published evidence reviews have no minimum trial size for reliability. The British Medical Journal (BMJ), one of the most highly respected journals in the world, sets their minimum for quality at 20 participants. Add to this the fact that this arbitrary number was decided upon in a post-hoc analysis, the accusation of bias is hard to dismiss. .[iv] You can read more about it here. https://www.hri-research.org/resources/homeopathy-the-debate/the-australian-report-on-homeopathy/australian-report-faqs/
Practically, this means that the NHMRC very conveniently dismissed some of the best and most reliable studies[v] that homeopathy has to offer, such as Reilly's 1986 study on pollen with a sample size of 144 people[vi], and Jennifer Jacobs study on paediatric diarrhea in Nepal with a sample size of 126[vii]. According to the Homeopathic Research Institute, had NHMRC actually used BMJ's threshold of 20 participants then 166 of the 176 studies considered would have been considered.[viii]
The NHMRC used an additional criteria for quality, a grading system who's mechanics and definitions were never disclosed, creating a significant lack of transparency and trust in their assessment.
When the Australian Homeopathic Association (AHA) learned of this report, they made a Freedom of Information Request to get a better understanding of what had happened with this study. What they uncovered was simply unbelievable - there had been, in fact, a previous review, also commissioned by the NHMRC. This second review had been buried! What could the implication be, you ask?
Upon further investigation, the AHA learned that a very respected scientist conducted the first review, Prof Karen Grimmer, who had actually developed the NHMRCs quality guidelines. That study had been well received, and yet the NHMRC quickly and silently buried it, while commissioning a completely new study. After a strong campaign led by the Homeopathic Research Institute (HRI), the Australian Homeopathic Association, and a petition that had gathered almost 75 000 signatures, the NHMRC finally released the first report in August of 2019.[ix]
What Was Found in the First Report?
The first report concluded that there is encouraging evidence for homeopathy in 5 conditions: fibromyalgia, ear infections, upper respiratory tract infections, side effects of cancer treatment, and post-operative ileus (first time to flatus after surgery). I want to clarify that this doesn't mean that the evidence was negative in other areas, only that there weren't enough high quality trials to make a proper assessment.
This is not absolute proof that homeopathy works, but it is a far cry from the notion that there is no evidence in its favour. The truth of the matter is that we need to do more research, but funds for this kind of work is extremely limited. Even though excellent research is slowly trickling out, we still have a long way to go, and scientists have a hard time building a career while focusing on alternative medicine. And, the NHMRC report, released in 2015, only made matters worse. Such a negative message in the public eye led to even less funding being available for new homeopathic studies.
If you're wondering whether the first report was buried due to quality issues, according to the Homeopathic Research Institute:
The First Report is in draft form and as such it is not a ‘perfect' finalized document. However, the report was sufficiently well-formed to have undergone peer review. FOI requests revealed that a member of NHMRC's committee overseeing the review process considered the first review to be high quality saying, "I am impressed by the rigor, thoroughness and systematic approach given to this evaluation [….] Overall, a lot of excellent work has gone into this review and the results are presented in a systematic, unbiased and convincing manner."4 (Professor Fred Mendelsohn, NHMRC Homeopathy Working Committee).[x]
The rabbit hole keeps getting deeper, and I must admit I'm horrified at the prospects of where we may find ourselves as the evidence for fraud in this and other medical research escalates.
To rub salt in the wound, NHMRC released the report with annotations from their CEO, Professor Anne Kelso. The notes insinuate that this review is of low quality (very much in opposition to the panel's previous comments on the review). The Author, Dr. Grimmer, was never given the opportunity to respond to these notes before the release of the report.
"This gives the impression that Prof Grimmer has not given sufficient consideration to the quality of the evidence being reviewed - a remarkable claim given her expertise and experience in using the FORM approach. In fact, risk of bias is one of the factors the author would have considered when assigning a ‘grade' to the evidence base for each medical condition (grading it from A-D). Risk of bias is therefore integrated within the report's findings throughout, as well as being presented directly in the main text of each chapter."[xi]
Just to reiterate, Dr. Grimmer is considered a foremost expert in the FORM approach[xii] the framework that the Australian government has adopted for guideline development, it is misleading to assume her work is of inferior quality, these comments represent a petty attempt to discredit the report and save face.
So what does this all mean?
In essence, the results of this misconduct have enormous ramifications. They are a clear sign that the evidence base on which modern medicine proclaims to ground itself is not objective. There are forces with unfathomable resources working hard, covertly, and with a long-term strategic plan to manipulate the evidence base in order to protect and grow their profits. Everything we are told by the medical industry needs to be viewed through a lens of protectionism and profits. Despite many important discoveries we have to question the motives underlying scientific headlines in the news. It is almost impossible to sift through all this without a solid scientific foundation and plenty of time, something the average person cannot practically accomplish. It is thanks to watchdogs like the Homeopathic Research Institute that this information is coming out. But, with so much at stake for media companies - dependent on pharmaceutical advertising funding - there is almost no chance that this information will get the broad and deep coverage it deserves.
Please visit the HRI website for more information and consider donating https://www.hri-research.org/
[i] Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy Shang et al, The Lancet, P726-732, AUGUST 27, 2005 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67177-2/fulltext
National Health and Medical Research Council of Australia Systematic Review on Homeopathy
BMJ Clinical Evidence (2016) Nuts, bolts, and tiny little screws: how Clinical Evidence works. [Link] (Accessed: 18th February 1016) From HRI - website has changed since
[vii] Jacobs J, Jimenez M, Malthouse S, Chapman E, Crothers D, Masuk M, Jonas W. Homeopathic Treatment of Acute Childhood Diarrhea: Results from a Clinical Trial in Nepal. The Journal of Alternative and Complementary Medicine 2000; Vol. 6, No. 2: 131-139.
(Accessed Oct. 10, 2018)
Release of NHMRC Homeopathy Review 2012: Questions and Answers
[xii] https://www.springermedizin.de/the-australian-form-approach-to-guideline-development-the-quest-/9432396 (accessed on Dec.8, 2019)