Tuesday, 8 August 2017

The Australian Report (on homeopathy). A travesty of evidence and science!

I commented in my last blog that conventional medical doctors are often in denial. They tell us that their drugs and vaccines are safe, even though they might have some 'minor side' effects. They deny the effectiveness of homeopathy. Both are denials that causes so much patient harm.

Yet it is not just denial. The conventional medical establishment, led by the powerful pharmaceutical industry, is frequently found to be openly attacking any medical therapy that is an alternative to its dominance, its monopoly of national health services, anywhere in the world.

What is happening in Australia at present is not only illustrative of these attacks,but  it shows the depths to which Big Pharma is prepared to plummet, the lies it is prepared to tell, the facts it is prepared to cover up, and the medical science it is prepared to undermine and taint in doing so.

Particular thanks has to be given to the Homeopathy Research Institute (HRI) in uncovering the the true depth to which conventional medicine, and the pharmaceutical industry, is prepared to sink in order to attack homeopathy. So their article on 'The Australian Report' is the basis for much of this blog.

In March 2015, the Australian National Health and Medical Research Council (NHMRC) published an 'Information Paper' on homeopathy, often referred to as ‘The Australian Report’, which concluded:

               “…there are no health conditions for which there is reliable evidence that homeopathy is effective”.

This finding was sufficient to trigger headlines around the world, written by a compliant, pharma friendly media, that the NHMRC had found that homeopathy does not work for any condition.

This was not the first report to make such a claim, and with conventional medicine failing to cope with the epidemics of chronic disease around the world, and the pharmaceutical companies failing to come up with new drugs or vaccines that are either safe or effective, it is not likely be the last. 

What is significant about the Australian Report total disregard conventional medicine, and its apologists, has for the integrity of medical science. Following an extensive and detailed investigation, of the Report, the HRI was able to reveal "evidence of serious procedural and scientific misconduct in producing this report", and it was able to outline these key facts about the Australian Report.

  • NHMRC did the homeopathy review twice, producing two reports, one in July 2012 and the one released to the public in March 2015.
  • The existence of the first report has never been disclosed to the public. It was only discovered by AHA through Freedom of Information (FOI) requests.
  • NHMRC say they rejected the first report because it was poor quality despite it being undertaken by a reputable scientist and author of NHMRC’s own guidelines on how to conduct evidence reviews.
  • FOI requests have revealed that a member of NHMRC’s expert committee overseeing the review process, Professor Fred Mendelsohn, confirmed the first review to be high quality.  saying,  “I am impressed by the rigor, thoroughness and systematic approach given to this evaluation of the published reviews of efficacy and side effects of homeopathy [….] Overall, a lot of excellent work has gone into this review and the results are presented in a systematic, unbiased and convincing manner.” 
  • NHMRC said the results of the report published in 2015 were based on a “rigorous assessment of over 1800 studies”. In fact results were based on only 176 studies.
  • NHMRC used a method that has never been used in any other review, before or since. NHMRC decided that for trials to be ‘reliable’ they had to have at least 150 participants and reach an unusually high threshold for quality. This is despite the fact that NHMRC itself routinely conducts studies with less than 150 participants.
  • These unprecedented and arbitrary rules meant the results of 171 of the trials were completely disregarded as being ‘unreliable’ leaving only 5 trials NHMRC considered to be ‘reliable’. As they assessed all 5 of these trials as negative, this explains how NHMRC could conclude that there was no ‘reliable’ evidence.
  • Professor Peter Brooks, Chair of the NHMRC committee that conducted the 2015 review, initially failed to declare that he was a member of the anti-homeopathy lobby group ‘Friends of Science in Medicine’.
  • In violation of NHMRC’s own guidelines there was not one homeopathy expert on the committee.

So, as a result, in August 2016, the HRI’s in-depth scientific analysis became part of a submission of complaint to the Commonwealth Ombudsman, brought by Complementary Medicines Australia, the Australian Homoeopathic Association, and the Australian Traditional Medicine Society. This is what Rachel Roberts, Chief Executive of HRI said about the report, and the reason for the complaint.

               “NHMRC’s review is just bad science. Decision-makers and the scientific community rely on these kinds of reports and need to trust their accuracy. This is not about anyone’s personal opinion as to whether homeopathy works or not. It is about the importance of evidence being reported objectively, whatever it says, and the NHMRC did not do that.”

This is something that has rarely happened with so-called official reports on homeopathy.The full HRI analysis goes into some 60 pages, which cannot be shared whilst the complaint is ongoing, but the data provided details that demonstrated the spuriousness of the science used.

  • Use of an inappropriate scientific method
  • Failure to use standardised, accepted methods
  • Failure to obtain sufficiently accurate data to perform a meaningful review
  • Failure to conduct an effective preliminary and public consultation
  • Significant post-hoc changes to the research protocol
  • Impact of NHMRC’s unusual method on the review results
  • Further evidence of bias and misreporting
  • Poor reporting – lack of clarity, inconsistencies and errors
  • Evidence that this was a case of deliberate bias, not scientific error.

So it would appear that most of these failings are not too different from the failings of the pharmaceutical industry when conducting its research into new pharmaceutical drugs and vaccines! Rachel Roberts is quoted as saying, in the HRI article.

               “The public has a right to know that there are high quality studies showing homeopathy works for some medical conditions, such as hay fever, sinusitis and diarrhoea in children – information that was lost only due to NHMRC’s mishandling of the evidence. If the evidence on conventional medicine was treated this way there would be an outcry - and rightly so. NHMRC’s job was to accurately summarise the body of evidence for homeopathy for the public, a task in which they categorically failed.”

So, I hear you ask, what happened to the first NHMRC report into homeopathy? NHMRC initially worked with an external contractor, from April 2012 to August 2012, in order to produce a review of the evidence on Homeopathy to inform the Australian public. It was called "A Systematic Review of the Evidence on the Effectiveness of Homeopathy" but was never made public. Moreover, NHMRC continue to refuse to release it, despite repeated Freedom of Information requests. What is known is that the contract with the first review team was terminated. It seems likely that they did not come up with the 'correct' result! The new external contractor, OptumInsight, was more 'successful', although it required over two years, from December 2012 to March 2015, to manipulate and overcome the evidence!

In criticising the accuracy of the Australia Report, HRI discovered that it was not alone. HRI states that FOI requests brought to light that two independent experts also raised concerns over the conclusions of the 2015 report, as part of its peer review process, prior to final publication. Apparently the Australasian Cochrane Centre commented that “...'no reliable evidence’ does not seem an accurate reflection of the body of evidence”. Similarly; a second expert felt “uncertain of the definitive nature of the Report’s conclusions”. 

Yet despite this, as the HRI states, NHMRC chose not to act on this feedback. They did not amend their conclusions. These experts, too, had failed to come to the 'right' conclusion, the conclusion required by NHMRC! They had failed to understand that this was not really a discussion document. A firm negative conclusions was required that proved the ineffectiveness of homeopathy, and nothing would be allowed to stand in the way of this - certainly not science!

The Australian Report was designed to provide a conclusive, but hopelessly unscientific summary of the findings of a review of systematic reviews. The HRI seeks to explain their mistake, that they confused ‘lack of evidence of effect’ with ‘evidence of a lack of effect’. They say that the Report’s conclusion, that there is ‘no reliable evidence’ that homeopathy works, was 'widely misunderstood', with people believing it meant that the NHMRC had found that homeopathy did not work, and that this misunderstanding triggered the widespread media coverage, "propagating the inaccurate story that the NHMRC found homeopathy to be no better than placebo for all the conditions." The HRI goes on to explain that the scientific analysis had revealed multiple examples of bias and misreporting, and that this explained how NHMRC arrived at such a definitive and negative position, at odds with the conclusions of the majority of other more academically rigorous systematic reviews and meta-analyses on homeopathy. It continued

               "Most crucially, NHMRC’s findings hinge primarily on their definition of reliable evidence: for a trial to be deemed ‘reliable’ it had to have at least 150 participants and a quality score of 5/5 on the Jadad scale (or equivalent on other scales). Trials that failed to meet either of these criteria were dismissed as being of ‘insufficient quality and/or size to warrant further consideration of their findings’. Setting such a high quality threshold is very unusual, but the N=150 minimum sample size criterion is arbitrary, without scientific justification, and unprecedented in evidence reviews."

               "Out of 176 individual studies the NHMRC included in the homeopathy review, only 5 trials met their definition of ‘reliable‘, none of which, according to their analysis, demonstrated effectiveness of homeopathy. This explains why NHMRC concluded there is ‘no reliable evidence’ that homeopathy is effective. For context it is worth remembering that if it was indeed the case that ‘no reliable evidence’ existed for homeopathy, it would put homeopathy in the same evidence category (“unknown effectiveness”) as 46% of conventional treatments used in the NHS, but in fact this conclusion is inaccurate."

It was magnanimous of HRI to try to explain what NHMRC may have done to get their conclusion so wrong! It is quite possible to come to a less favourable interpretation about what has happened, and what the Australian Report represents. It is this.

There was no 'confusion' in what they did, there was no 'mistake' made in the criteria selected. The report was written and published by a group of people, all within the conventional medical establishment, and what they did, what they said in the report, was what they fully intended to say, quite regardless of the evidence. It was a malignly crafted Report that was intended to be exactly what it was - another hostile, gratuitous attack on homeopathy. It purposely aimed to discredit a rival medical therapy, one that is seen increasingly to be a threat to the dominance of pharmaceutical interests.

Yet the HRI is correct in it final remark about the Australian Report, one it has arrived at as a result of many years of tireless scientific work. So I will give them the final say, and emphasise it.

               "Contrary to NHMRC’s findings, there are ‘good quality, well-designed studies with enough participants for a meaningful result‘ ... which show that certain homeopathic treatments are effective for certain conditions such as hay fever, sinusitis, upper respiratory tract infections, diarrhoea in children and lower back pain. The fact that the results of such studies were unjustifiably dismissed means that NHMRC have misled the public by misreporting the evidence for effectiveness of homeopathy."