The Swiss government has a long and widely-respected history of neutrality, and therefore, reports from this government on controversial subjects need to be taken more seriously than other reports from countries that are more strongly influenced by present economic and political constituencies. When one considers that two of the top five largest drug companies in the world have their headquarters in Switzerland, one might assume that this country would have a heavy interest in and bias toward conventional medicine, but such assumptions would be wrong.
In late 2011, the Swiss government’s report on homeopathic medicine represents the most comprehensive evaluation of homeopathic medicine ever written by a government and was just published in book form in English (Bornhoft and Matthiessen, 2011). This breakthrough report affirmed that homeopathic treatment is both effective and cost-effective and that homeopathic treatment should be reimbursed by Switzerland’s national health insurance program.
The Swiss government’s inquiry into homeopathy and complementary and alternative (CAM) treatments resulted from the high demand and widespread use of alternatives to conventional medicine in Switzerland, not only from consumers but from physicians as well. Approximately half of the Swiss population have used CAM treatments and value them. Further, about half of Swiss physicians consider CAM treatments to be effective. Perhaps most significantly, 85 percent of the Swiss population wants CAM therapies to be a part of their country’s health insurance program.
It is therefore not surprising that more than 50 percent of the Swiss population surveyed prefer a hospital that provides CAM treatments rather to one that is limited to conventional medical care.
Beginning in 1998, the government of Switzerland decided to broaden its national health insurance to include certain complementary and alternative medicines, including homeopathic medicine, traditional Chinese medicine, herbal medicine, anthroposophic medicine, and neural therapy. This reimbursement was provisional while the Swiss government commissioned an extensive study on these treatments to determine if they were effective and cost-effective. The provisional reimbursement for these alternative treatments ended in 2005, but as a result of this new study, the Swiss government’s health insurance program once again began to reimburse for homeopathy and select alternative treatments. In fact, as a result of a national referendum in which more than two-thirds of voters supported the inclusion of homeopathic and select alternative medicines in Switzerland’s national health care insurance program, the field of complementary and alternative medicine has become a part of this government’s constitution (Dacey, 2009; Rist, Schwabl, 2009).
The Swiss Government’s “Health Technology Assessment”
The Swiss government’s “Health Technology Assessment” on homeopathic medicine is much more comprehensive than any previous governmental report written on this subject to date. Not only did this report carefully and comprehensively review the body of evidence from randomized double-blind and placebo controlled clinical trials testing homeopathic medicines, they also evaluated the “real world effectiveness” as well as safety and cost-effectiveness. The report also conducted a highly-comprehensive review of the wide body of preclinical research (fundamental physio-chemical research, botanical studies, animal studies, and in vitro studies with human cells).
And still further, this report evaluated systematic reviews and meta-analyses, outcome studies, and epidemiological research. This wide review carefully evaluated the studies conducted, both in terms of quality of design and execution (called “internal validity”) and how appropriate each was for the way that homeopathy is commonly practiced (called “external validity”). The subject of external validity is of special importance because some scientists and physicians conduct research on homeopathy with little or no understanding of this type of medicine (some studies tested a homeopathic medicine that is rarely used for the condition tested, while others utilized medicines not commonly indicated for specific patients). When such studies inevitably showed that the homeopathic medicine did not “work,” the real and accurate assessment must be that the studies were set up to disprove homeopathy… or simply, the study was an exploratory trial that sought to evaluate the results of a new treatment (exploratory trials of this nature are not meant to prove or disprove the system of homeopathy but only to evaluate that specific treatment for a person with a specific condition).
After assessing pre-clinical basic research and the high quality clinical studies, the Swiss report affirmed that homeopathic high-potencies seem to induce regulatory effects (e.g., balancing or normalizing effects) and specific changes in cells or living organisms. The report also reported that 20 of the 22 systematic reviews of clinical research testing homeopathic medicines detected at least a trend in favor of homeopathy.* (Bornhöft, Wolf, von Ammon, et al, 2006)
The Swiss report found a particularly strong body of evidence to support the homeopathic treatment of Upper Respiratory Tract Infections and Respiratory Allergies. The report cited 29 studies in “Upper Respiratory Tract Infections/AllergicReactions,” of which 24 studies found a positive result in favor of homeopathy. Further, six out of seven controlled studies that compared homeopathic treatment with conventional medical treatment showed that homeopathy to be more effective than conventional medical interventions (the one other trial found homeopathic treatment to be equivalent to conventional medical treatment). All of these results from homeopathic treatment came without the side effects common to conventional drug treatment. In evaluating only the randomized placebo controlled trials, 12 out of 16 studies showed a positive result in favor of homeopathy.
The authors of the Swiss government’s report acknowledge that a part of the overall review of research included one review of clinical research in homeopathy (Shang, et al, 2005). However, the authors noted that this review of research has been widely and harshly criticized by both advocates and non-advocates of homeopathy. The Swiss report noted that the Shang team did not even adhere to the QUORUM guidelines which are widely recognized standards for scientific reporting (Linde, Jonas, 2005). The Shang team initially evaluated 110 homeopathic clinical trials and then sought to compare them with a matching 110 conventional medical trials. Shang and his team determined that there were 22 “high quality” homeopathic studies but only nine “high quality” conventional medical studies. Rather than compare these high quality trials (which would have shown a positive result for homeopathy), the Shang team created criteria to ignore a majority of high quality homeopathic studies, thereby trumping up support for their original hypothesis and bias that homeopathic medicines may not be effective (Lüdtke, Rutten, 2008).
The Swiss report also notes that David Sackett, M.D., the Canadian physician who is widely considered to be one of the leading pioneers in “evidence based medicine,” has expressed serious concern about those researchers and physicians who consider randomized and double-blind trials as the only means to determine whether a treatment is effective or not. To make this assertion, one would have to acknowledge that virtually all surgical procedures were “unscientific” or “unproven” because so few have undergone randomized double-blind trials.
In my view, for a treatment to be determined to be “effective” or “scientifically proven,” a much more comprehensive assessment of what works and doesn’t is required. Ultimately, the Swiss government’s report on homeopathy represents an evaluation of homeopathy that included an assessment of randomized double blind trials as well as other bodies of evidence, all of which together lead the report to determine that homeopathic medicines are indeed effective.
The next article will discuss further evidence provided in this report from the Swiss government on the effectiveness and cost-effectiveness of homeopathic care.
Bornhoft, Gudrun, and Matthiessen, Peter F. Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs. Goslar, Germany: Springer, 2011. http://rd.springer.com/book/10.1007/978-3-642-20638-2/page/1 (This book is presently available from the German office of the publisher, and it will become available via the American office as well as select booksellers in mid- to late-February, 2012.)(NOTE: When specific facts in the above article are provided but not referenced, this means that these facts were derived from this book.)
Bornhöft G, Wolf U, von Ammon K, Righetti M, Maxion-Bergemann S, Baumgartner S, Thurneysen AE, Matthiessen PF. Effectiveness, safety and cost-effectiveness of homeopathy in general practice – summarized health technology assessment. Forschende Komplementärmedizin (2006);13 Suppl 2:19-29. http://www.ncbi.nlm.nih.gov/pubmed/16883077
Dacey, Jessica. Therapy supporters roll up sleeves after vote. SwissInfo.ch, May 19, 2009. http://www.swissinfo.ch/eng/politics/Therapy_supporters_roll_up_sleeves_after_vote.html?cid=670064
Linde K, Jonas W. Are the clinical effects of homeopathy placebo effects? Lancet 36:2081-2082. DOI:10.1016/S0140-6736(05)67878-6. http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673605678786.pdf
Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analysed trials. Journal of Clinical Epidemiology. October 2008. doi: 10.1016/j.jclinepi.2008.06/015. http://www.jclinepi.com/article/S0895-4356(08)00190-X/abstract
Rist L, Schwabl H: Komplementärmedizin im politischen Prozess. Schweizer Bevölkerungstimmt über Verfassungsartikel «Zukunft mit Komplementärmedizin» ab. Forsch Komplementmed 2009, doi 10.1159/000203073.
(Translation: Complementary medicine in the political process: The Swiss population votes on the Constitutional Article “The future with complementary medicine”
*Although this Swiss government report was just published in book form in 2011, the report was finalized in 2006. In light of this date, the authors evaluated systematic reviews and meta-analyses on homeopathic research up until June 2003.
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