Homeopathy and The Lancet

The Lancet of August 27, 2005 featured a cluster of articles highly critical of homeopathy which attracted considerable media attention. The media reports echoed The Lancet’s press release: ‘homeopathy is no better than placebo’. The centerpiece was a meta-analysis of clinical trials of homeopathy compared with clinical trials of allopathy (conventional medicine) (1). The first author is Aijing Shang, but the leader of the research group is Prof. Matthias Egger of the Department of Social and Preventive Medicine, University of Berne, Switzerland. The meta-analysis formed part of the Complementary Medicine Evaluation Programme (Programm Evaluation Komplementärmedizin, PEK) financed by the Swiss Federal government. The international review board of PEK has publicly protested at political interference in the scientific process: ‘There is a consensus among the review board members that the final PEK process deviated from what would have been expected by conventional standards. Especially disconcerting was the fact that the products of the PEK process—health technology assessment (HTA) reports, single description of studies, manuscripts for publication and the condensed final report—were sent to the board members but no discussion, comment, or review was solicited by the responsible agencies’ (2). The meta-analysis was accompanied by a short, anonymous editorial entitled ‘The end of homoeopathy’ calling for ‘doctors to be bold and honest with their patients about homeopathy’s lack of benefit, and with themselves about the failings of modern medicine’ (3); and a more thoughtful commentary from the Dutch epidemiologist Jan Vandenbroucke, reflecting on the ‘growth of truth’, including the relationship between bias, background knowledge and the concordance of clinical results with laboratory science findings (4). Vandenbroucke concludes that the proof of the pudding is in the eating: the ultimate proof of the validity of a scientific or medical idea is extent to which it changes reality. The same issue of The Lancet featured a leak of the World Health Organisation’s (WHO) draft report on homeopathy. The WHO document was apparently leaked to The Lancet by Dutch and Belgian doctors hostile to homeopathy; their comments and the (hostile) comments of Prof. Edzard Ernst of the University of Exeter were published. Dr Xiaorui Zhang, Traditional Medicine Coordinator of WHO, who is responsible for the report, was also interviewed, but declined to comment on a leaked, confidential draft. This leak came only 2 days after The Times of London published, as its front page lead, a remarkably similar story: a leak of the Smallwood Enquiry on The Role of Complementary and Alternative Medicine in the NHS commissioned by The Prince of Wales’ Foundation for Integrated Health. It is ironic that the editor of The Lancet, Dr Richard Horton, wrote to The Times accusing Prof. Ernst of having ‘broken every code of scientific behaviour’ for leaking the draft report of the Smallwood Enquiry (and incidentally describing complementary medicine as ‘a largely pernicious influence. . . preying on the fears and uncertainties of the sick’), while simultaneously doing the same to the WHO report in his own journal! Dr Horton also wrote an open letter to the UK Secretary of State for Health, Patricia Hewitt and the Chairman of the National Institute for Clinical Excellence (NICE) Prof. Sir Michael Rawlings, calling for the use of homeopathy in the NHS to be reviewed in light of this publication.