(Essen, 14.07.2010) It was only a matter of time before the health-policy debate extended to complementary medicine. The cover story of the current issue of SPIEGEL has now set the ball rolling.
That homeopathy in particular has been chosen as the focal point is not surprising. It is the method within complementary medicine about which opinions differ most widely. Some politicians are now using the statements in SPIEGEL as an opportunity to comment on the role of homeopathy in statutory health insurance (GKV).
Pragmatism instead of trench warfare
The SPIEGEL piece itself bears the headline "The great Schüttelfrust". It speaks of irreconcilable hostility between supporters and opponents, between "unrestrained believers and well-founded critics", and claims the tone is becoming "rougher, the dispute more brutal."
The opposite is true: in everyday care (medical practices, hospitals, medical associations, health insurers, medical faculties) there are numerous good examples of successful cooperation. Independently of health policy and lobbying, replacing the ideological trench warfare the author seeks to impose on us is a pragmatism oriented to the welfare and wishes of patients.
Homeopathy at universities
Even at the medical faculties of university clinics there is increasing willingness to cooperate: at many universities homeopathy is an established teaching component in Cross-sectional Area 12, which is taught as a compulsory subject. In the summer semester of 2010 almost one in three universities also offered the elective "Homeopathy" to medical students.
SPIEGEL, however, attempts to revive old enemy images and dig up trenches that have long been filled in. The attempt to set supporters of both sides against each other again does not help the matter. Objectivity is more necessary than ever – unfortunately this is lacking in key points in the article:
1. On the claim that the effectiveness of homeopathy has been scientifically refuted
SPIEGEL asserts there is "not the slightest convincing evidence that homeopathic pellets have any effect other than a placebo effect." This statement is demonstrably false (unless one interprets the little word "convincing" to mean that nothing can be convincing that does not fit the author's worldview). Modern proof of effectiveness (in the sense of randomised, placebo-controlled trials) exists, for example, that the homeopathic remedy Galphimia glauca is effective in the treatment of hay fever, that individualised homeopathic treatment of childhood diarrhoea can significantly reduce the frequency and severity of stools compared with placebo, and that homeopathic treatment relieves the pain of fibromyalgia patients. For this reason homeopathy has been included in the official guideline for the treatment of fibromyalgia.
It therefore cannot be said that homeopathy is "refuted". It is a myth that "for at least ten years all well-conducted, systematic reviews and meta-analyses have uniformly reached this result". Anyone who reads the conclusions of these works will find cautiously positive and predominantly negative remarks, but none that speak of "proof" of non-effectiveness.
Overall SPIEGEL is unfortunately very imprecise in its formulations. Scientifically clearly defined terms such as benefit, effect and efficacy are carelessly mixed. Thus, according to SPIEGEL the chairman of the Federal Joint Committee, Rainer Hess, goes so far as to claim that the benefit of homeopathy is not proven. What he probably means is something entirely different: namely the specific efficacy of homeopathic medicines. That a homeopathic treatment benefits the patient can now be considered undisputed.
2. On the significance of the 10:23 action in Great Britain
That science is not the intention of the SPIEGEL article is also shown by the prominent placement of the English protest action against homeopathy "10:23" in the piece, although it has no scientific value whatsoever. It is more than disconcerting to speculate about the problem of allegedly poor-quality studies on homeopathy while at the same time citing a medical-ethically highly questionable campaign as proof of ineffectiveness.
3. On Prof. Karl Lauterbach's demand that reimbursement for homeopathy should be banned
Statutory health insurers can reimburse homeopathic treatment, but they do not have to! Lauterbach's demand to ban a voluntary benefit makes little sense. On the one hand competition between health insurers is supposed to be strengthened, on the other hand scope for shaping benefits is to be restricted? The zigzag course continues.
There are various reasons why about half of the funds reimburse homeopathy. These reasons must in any case be convincing, because homeopathic treatment is evidently successful; and it meets the wishes of those insured.
4. On the costs of homeopathic medicines
Since the health reform of 2004, naturopathic and homeopathic medicines for adults may no longer be reimbursed with few exceptions. The costs are borne by the insured; this does not place a burden on the healthcare system. Before the reform, the costs of reimbursing homeopathic medicines were below one percent of the total medicines budget.
5. On statements by the designated head of IQWiG, Prof. Jürgen Windeler
Windeler's claim that "Homeopathy is a speculative, refuted concept" is not tenable. Like almost everyone who talks about homeopathy, he makes the mistake of defining homeopathy through potentisation. The central basic principle of homeopathy, however, is not potentisation but the principle of similars ("like cures like"; not: "the same with the same", as SPIEGEL writes). Whoever speaks of the concept of homeopathy must examine the principle of similars and nothing else. In this respect the "homeopathic concept" is neither proven nor refuted.
Apart from that Windeler says: "there's no need to research this further, the matter is settled." In doing so he ignores the state of research and the will of the population. If science becomes an end in itself and does not concern itself with patients' problems, Windeler need not complain in SPIEGEL that "people don't care what conclusions science reaches." Research into homeopathy is clearly in the public interest; further research is urgently needed.
6. On statements by Prof. Edzard Ernst
So-called observational studies, according to Ernst, cause every "methodologist only a mild smile", since "you can prove any nonsense with them". The opposite is true: because of their complexity they are more likely to make a methodologist sweat than smile.
Observational studies are the most important instrument for describing real-world healthcare. They form an important building block in assessing whether and under what circumstances a therapy is of benefit. It only becomes nonsense if the results are not interpreted appropriately.
Incidentally, it is telling that the author chooses Ernst as his star witness against homeopathy. SPIEGEL says: "Arguments from homeopaths simply bounce off Ernst like a concrete wall."
7. On the claim that the Karl and Veronica Carstens Foundation supports research into homeopathy "benevolently"
This statement is false. According to the Carstens Foundation's understanding, science is per se open to results, not "benevolent". Valid research results must not be shaped by institutional or personal interests. The Foundation's publication policy clearly demonstrates this attitude: negative results are published as unreservedly and in full as positive ones.
That this practice is not maintained in the pharmaceutical industry, on the other hand, the author of the SPIEGEL piece knows best: in his book "Sick Business: How the Pharmaceutical Industry Manipulates Us" he deals with politics, research and lobbying by pharmaceutical companies on almost 300 pages.
8. On the claim that homeopaths are anti-vaccination
Unfortunately SPIEGEL repeats a frequently voiced prejudice without further research. To date there is not a single survey showing that "the anti-vaccination stance popular among homeopaths" exists. On the contrary: the only survey of general practitioners and paediatricians about their vaccination behaviour concluded that homeopaths cannot be categorically classified as anti-vaccination.
(http://www.carstens-stiftung.de/nachwuchs/promotionsfoerderung/abstracts/hom/lehrke.pdf)
9. Toad poison and Nazi homeopathy
The attempt to make homeopathy seem bizarre with eccentric examples from the "Materia Medica" is nothing new. The reference to Nazi activities is also a frequently cited point by opponents of homeopathy. These attempts at discrediting do not contribute to a factual discussion. Rather, the choice of these examples sheds light on the author's intentions.
Conclusion: The article in SPIEGEL will stimulate the debate on homeopathy, and on complementary medicine in general. The Karl and Veronica Carstens Foundation as a scientific organisation and its supporting association "Natur und Medizin e.V." as a patient representation welcome the discussion, as long as facts and arguments are at the centre. Agitation, scaremongering and a shocking ignorance of the facts, as presented by SPIEGEL, do not advance the matter. |
