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That’s how lobbying works: Edzard Ernst and the “Evidence Check 2: Homeopathy” (UK House of Commons)

Von Imke Plischko | 26.März 2010

“That’s how lobbying works”: A committee of the UK House of Commons has just come to the conclusion that homeopathic medicines are nothing more than placebos. The “reviewers” have requested the government to exclude homeopathy from the list of services covered by the National Health Service (NHS) and discontinue research in this area. However, a closer scrutiny of the evaluation criteria and the process and procedures of the “report” raises serious doubts about its validity. The report does not reflect the current state of international research, and in our view, its key issues reflect the personal opinion of a single person: Professor Edzard Ernst. The editorial staff of Heilpraxisnet.de has requested the journalist, Claus Fritzsche, to give his assessment of this issue.

Photo: Claus Fritzsche is a freelance journalist. His areas of specialization are holistic health, complementary medicine and research, and border areas of psychology.

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Mr. Fritzsche, the report issued by the UK House of Commons Science and Technology Committee concludes that homeopathic medicines are not effective and should therefore not be funded or approved. How do you assess the quality of this report?

Claus Fritzsche: Considering the still many open questions, I’d rather not offer a final judgment on this issue at this time. However after skim-reading the 275-page report, it is apparent that Evidence Check 2: Homeopathy gives a false picture of the current state of research on homeopathy and fails to provide transparency on the process and procedures used.

In my opinion, the UK House of Commons Science and Technology Committee put on a big show … which however does not answer the question as to why, of the arguments put forth at the public hearing, those of Prof. Harald Walach and Prof. George Lewith were ignored without comment and those of Prof. Edzard Ernst dominate the report.

There is much evidence that the results of the “report” were already established before the public hearing and that – not transparent for the public – Edzard Ernst pulled the strings in the background. In any case, the hearing was merely a token event.

Can you be more precise?

Claus Fritzsche: As far as I can judge at the moment, all of the arguments put forth in the “report” – and I emphasize the quotation marks – are largely based on a single meta-analysis. On page 22 of the report, Prof. Edzard Ernst is quoted as saying:

“Professor Ernst pointed out that: … 5. Shang et al very clearly arrived at a devastatingly negative overall conclusion.”

This quote refers to the dubious paper on the basis of which the British medical journal, The Lancet, somewhat prematurely proclaimed the “end of homeopathy” and, believe it or not, it did this on the basis of only eight studies.

What exactly are you criticizing?

Claus Fritzsche: Mr. Ernst fails to mention the fact that the meta-analysis conducted by Shang et al. in 2005 has meanwhile been refuted by papers published by Lüdtke/Rutten in the Journal of Clinical Epidemiology and Rutten/Stolper in the Journal of Homeopathy. The flaws of the meta-analysis were so blatant that even Elsevier (publisher of The Lancet) felt compelled to publish the press release New Evidence for Homeopathy.

I see the fact that Ernst completely fails to mention the papers published by Lüdtke, Rutten and Stolper as a deliberate attempt to mislead and deceive the public. It’s the same as if Toyota were to publish a report on the quality of its vehicles but keep the current recall campaign secret.

[Please note comment no. 1 at the end of this interview.]

Did the UK “report” not have to undergo a review process?

Claus Fritzsche: That’s a very good question. In any review process carried out according to international standards, the reference to Shang et al. 2005 without simultaneous mention of Lüdtke, Rutten and Stolper would be disputed. When such a major blunder occurs, it can be assumed that there’s a lot of manipulating and wheeling and dealing going on behind the scenes.

Who provided the scientific expertise in the “report”?

Claus Fritzsche: That’s another good question that I can’t answer. What is certain is that the persons cited on page four as responsible for the “report” do not possess the necessary scientific expertise in this matter. It is also certain that the report does not account for who analyzed results of the public hearing, which criteria were used, and who finalized the report. We also don’t know who decided which items of evidence should be included in the report and which should be left out. I’d really be interested in getting an answer to this question.

Do you have any assumptions?

Claus Fritzsche: (laughs) Since I have the feeling that the report quotes Edzard Ernst at least thirty times on every page, the evaluation criteria reflect Edzard Ernst’s well known personal opinion … and as the paper also contains the typical flaws of Edzard Ernst like failing to mention Lüdtke, Rutten and Stolper, overrating the criterion “plausibility”, and uncritical favoring of randomized controlled trials (which apart from their strengths also have major weaknesses), I think the answer to this question is quite simple.

I can’t tell you if he wrote the report himself or if he only acted as the prompter. For me it’s certain that Edzard Ernst pulled the strings in the background – in a manner not transparent to the public.

In our preliminary discussion you mentioned a “rival report” on homeopathy issued on behalf of the Swiss government. What exactly did this report examine?

Claus Fritzsche: The Swiss Federal Office for Public Health in 2005 published a Health Technology Assessment Report on homeopathy within the framework of the “Program of Evaluation of Complementary Medicine (PEK)”. The objective of the PEK was to scientifically examine five important complementary therapies (anthroposophical medicine, homeopathy, neural therapy, herbal medicine, and traditional Chinese herbal therapy). The PEK study consisted of a field study project and a literature analysis. Scientific monitoring was conducted by a steering committee, a panel of experts, and an internationally staffed review board.

How do the UK House of Commons “report” and the Swiss HTA report differ?

Claus Fritzsche: For a start, the Swiss PEK study was conducted over a period of seven years. The analysis of data and clarification of conceptual issues took five years. And two years were needed for the actual evaluation and creation of the HTA report.

Persons interested in participating in the UK public hearing on Evidence Check 2: Homeopathy had exactly 17 days to submit a response. This clearly shows that the study was orchestrated. The public should be induced to think that the study was based on a broad knowledge base when, in fact, it was not.

Who examined the data in the Swiss study?

Claus Fritzsche: In the Swiss HTA study there was complete transparency as to who evaluated the data, which criteria were applied and how the conclusions were drawn. All of these aspects are unclear and opaque in the UK “report”. The second major difference is the fact that the Swiss report is based on international expertise, whereas the UK report is based on domestic expertise only. And although UK expertise, represented by Edzard Ernst, George Lewith, and Harald Walach (who now works in Frankfurt (Oder)) would have sufficed, the knowledge and expertise of the latter two persons were, for no apparent reason, not taken into account at all.

Does the evaluation criteria used in the two reports differ?

Claus Fritzsche: Yes, it does. The Swiss study was based on international standards and the UK study, as I see it, was based on Edzard Ernst’s own personal assessment of the issue.

What does this mean in concrete terms?

Claus Fritzsche: Please allow me to start with a brief introductory comment: As I recently described using three examples in “Dubious meta-analyses: How evident is evidence-based medicine?”, researchers can relatively easily “shape” their results in a desired direction. If the evaluation criteria is skillfully chosen the same set of data can, in the name of truth and science, quite easily be “shaped” into POSITIVE or NEGATIVE results.

Did the UK “report” make use of this possibility?

Claus Fritzsche: Yes, that’s exactly the case. The Swiss HTA study was conducted in accordance with common international practice. The type of study they used was suited to the issue at hand. If you want to find out whether a particular type of treatment is effective under everyday conditions, then randomized controlled trials (RCTs) are less suitable for this purpose because of their limited external validity. Other study types, like the observational study, have a much higher external validity and are therefore used in healthcare research to determine the effect of a particular treatment under everyday conditions.

However, if I want to know exactly what aspect of treatment works, then RCTs with their high internal validity are a suitable way of measuring this. Observational studies, case series and longitudinal cohort studies are less suitable for this purpose. RCTs are well suited for measuring specific and nonspecific effects. But even here, they not only have strengths but also serious weaknesses. RCTs are unable to appropriately measure the specific effects of complex interventions. Whether RCTs can be used to measure the effects of individualized homeopathic treatment is also controversial – in classical homeopathy each patient is given a medicine which fits both the person and the ailment.

In the Swiss HTA study, the method chosen was appropriately matched to the issue of research, as is common in international practice. However in the UK House of Commons “report”, randomized controlled trials were favored over other research methods. This overrating of the strengths of RCTs and underrating of their weaknesses are no longer accepted internationally and are inconsistent with the view of important authorities. The Advisory Council for Concerted Action in Healthcare of the German Federal Ministry of Health and Sir Michael Rawlins, Chairman of Britain’s National Institute for Health and Clinical Excellence, consider it wrong to unduly favor RCTs.

How does undue preference of RCTs affect the outcome of studies?

Claus Fritzsche: Experts like Klaus Linde of the German Cochrane Centre, Claudia Witt of the Berlin Charité or Rainer Lüdtke of the Karl und Veronica Carstens Foundation can explain the effects better than I can. Let me put it bluntly. A general preference of randomized controlled trials for all issues and disregard of the RCT’s well known weaknesses pay off in this particular case if I want to “shape” the outcome of the study to the detriment of homeopathy.

This form of outcome manipulation pays off in a political context like the one in Great Britain where competing experts are ousted and mass media (not experts) are the only supervisory authority. The typical run-of-the-mill journalist is unable to understand the issues explained here for lack of knowledge, time, and frequently also for lack of motivation. He or she tends to believe what the experts say and is easily lulled by scientifically sounding words.

At least that’s my opinion.

What did the results of the Swiss HTA report on homeopathy show?

Claus Fritzsche: The Swiss report came to the following conclusion:

“Taking internal and external validity criteria into account, effectiveness of homeopathy can be supported by clinical evidence and professional and adequate application be regarded as safe.”
(Source: Research in Complementary Medicine 2006; Vol. 13 (Suppl. 2); 19-29)

The Swiss HTA study does, however, leave the question open as to why this is so. This question is still the subject of research like the Homeopathic Pathogenetic Trials conducted by Harald Walach et al. and presented in my blog “New Study Design Documents Specific Effects”. The present results of the placebo-controlled, double-blind HAMP studies are spectacular and speak for the specific effects of homeopathy. In the public hearing conducted by the UK House of Commons, these results were submitted by Walach and Lewith in the form of a memorandum … however, ignored by the dubious Mr. X without indication of any reason. But that doesn’t surprise anyone. Because that’s how lobbying works … (laughs)

Mr. Fritzsche, thank you for this interview.

(www.heilpraxisnet.de, 02.03.2010)

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Ethically unacceptable:

Comment No. 1: Edzard Ernst mentioned Rutten, Stolper and Lüdtke indirectly by using the following misleading (ethically unacceptable) wording: „Probably, the review by Shang et al [2] has been criticised by homeopaths. While no review can ever be without limitations, these criticisms have been refuted. If needed, I can provide further written evidence on this issue.“ The truth ist that e.g. Lüdtke and Rutten published their re-evaluation „The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials“ in a peer-reviewed scientific journal. „These criticisms“ have NOT been refuted.

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[Annotation: This interview was originally published in German language at Heilpraxisnet.de. It is licensed under Creative Commons (CC) Attribution-No Derivative Works 3.0 Unported.]

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Follow Claus Fritzsche at Twitter …

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Related Links:

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Halloween Science: William Alderson about „Trick or Treatment?“ by Simon Singh and Edzard Ernst:

For five months, William Alderson, a founding trustee of H:MC21, worked on a thorough critique of Simon Singh and Edzard Ernst’s book „Trick or Treatment? Alternative medicine on trial“ (London: Bantam, 2008). The critique analyses each chapter in turn and details no less than nineteen major faults  in Ernst and Singh’s approach. It concludes that: “Trick or Treatment? has no validity as a scientific examination of alternative medicine”.

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Early Day Motion 908 – 23.02.2010 (www.parliament.uk):
SCIENCE AND TECHNOLOGY COMMITTEE REPORT ON HOMEOPATHY
Tredinnick, David

“That this House expresses concern at the conclusions of the Science and Technology Committee’s Report, Evidence Check on Homeopathy; notes that the Committee took only oral evidence from a limited number of witnesses, including known critics of homeopathy Tracy Brown, the Managing Director of  Sense About Science, and journalist Dr Ben Goldacre, who have no expertise in the subject; …”

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Tracey Brown – SourceWatch

Before becoming the director of Sense about Science, Brown was a senior analyst in the “Risk Analysis Unit” of the PR company, Regester Larkin. “Tracey is responsible for developing tailored forecasting and risk issue analysis for our clients,” her biographical note at the PR firm stated.[1] Regester Larkin specialises in “reputation risk management” and “crisis management, including countering campaigns by environmental, health and development NGOs. Regester Larkin’s clients are nearly all pharmaceutical, oil, or biotechnology companies, including BioIndustry Association, Shell Chemicals, TOTAL, Bayer, Pfizer, Aventis CropScience, and gas company BG Group. One her Sense About Science biographical note, Brown’s stint with Regester Larkin is cryptically referred to as being “a year in a more commercial environment to set up a risk research unit.”[2]

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TIMES ONLINE: Peer review of Prince’s study into alternative medicines
Letter to The Times from RICHARD HORTON (chief editor of The Lancet):

“Sir, Your report (August 24) that the Prince of Wales has commissioned a study that is wholly biased in favour of alternative medicine raises troubling questions. But not, as you and Professor Edzard Ernst seem to suggest, about a plot to introduce unproven treatments into the NHS.

Professor Ernst seems to have broken every professional code of scientific behaviour by disclosing correspondence referring to a document that is in the process of being reviewed and revised prior to publication. This breach of confidence is to be deplored …”
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Prof. Harald Walach: The campaign against CAM – a reason to be proud

(Source: Journal of holistic healthcare; Volume 6 Issue 1 May 2009)

“It should be obvious to everyone: for at least a few years now, there has been a concerted on-going campaign against complementary and alternative medicine (CAM). At first, it all seemed pretty innocuous: a meta-analysis published in The Lancet, claiming homeopathy was no better than placebo.1 It was heavily criticised on methodological grounds,2-4 and it contradicted The Lancet’s own tough criteria for publishing meta-analyses, but nevertheless, the editor of The Lancet proclaimed ‘the end of homeopathy’.

Then there was a letter (written without its consent on NHSheaded notepaper) calling on the NHS to cease offering CAM interventions such as homeopathy, as they are not ‘evidence based’. Articles in the print media and elsewhere began to appear, stating that the NHS should only use evidence based interventions that are scientifically vindicated and that CAM, not being evidence based, should not be publicly supported …”

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OnMedica Views: Houston we have a problem!
Elizabeth Thompson, Bristol:

“The Science and Technology committee Evidence Check into homeopathy has concluded that homeopathy is a placebo and placebos are not justified in the NHS. This view seems to have been heavily weighted by the opinions of Edzard Ernst Professor of CAM from Exeter University who has written extensively in the media calling for homeopathy to be removed from the NHS. In the science report he is quoted as saying “placebos are unreliable and there is lots of data to show that placebo effects are notoriously unreliable; somebody who responds today may not respond tomorrow; responses are not large in effect size and they are not usually long-lasting”.

However some large pieces of observational data from Europe and the UK, which were dismissed disparagingly as patient satisfaction surveys (which they were not but have been carried out separately in our department), suggest that homeopathy can indeed contribute to health gain and improvements in well being and quality of life in the long term 1-4. Also firmly concluding that homeopathy is a placebo does not reflect the evidence presented. The balance of the meta analyses done thus far, even those confining trials to high quality trials, suggest that we cannot conclude that homeopathy is just a placebo5 …”

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Themen: Imke Plischko | 10 Kommentare »

10 Kommentare to “That’s how lobbying works: Edzard Ernst and the “Evidence Check 2: Homeopathy” (UK House of Commons)”

  1. Homöopathie und UK-Pharmalobbyismus. DZVhÄ-Chef Curt Kösters: „Hut ab vor der Kampagnenfähigkeit dieser Leute!“ | H.Blog: Homöopathie & Forschung schreibt:
    28th.März 2010 um 09:52

    [...] That’s how lobbying works: Edzard Ernst and the “Evidence Check 2: Homeopathy” (UK House of Co… [...]

  2. edzard ernst schreibt:
    30th.März 2010 um 10:34

    sie ueberschaetzen meinen einfluss grenzenlos.ich war nur einer unter vielen,die als experten geladen waren.und das gesamte spektrum von befuerwortern bis zu kritikern war vertreten.es ehrt mich sehr,dass sie mir so viel zutrauen,aber sie irren sich gewaltig.

  3. Neuraltherapie.Blog schreibt:
    31st.März 2010 um 10:12

    Ja, Herr Ernst – genau dieser Eindruck sollte gegenüber der Öffentlichkeit vermittelt werden. ;-)

    Dieser Eindruck täuscht jedoch.

    Auf die von mir genannten offenen Fragen und Kritikpunkte sind Sie ja auch wohlweislich nicht eingegangen.

    Es war Teamarbeit, an der mehrere politische Strippenzieher beteiligt waren.

  4. Dr Peter Fisher: Response to Evidence Check 2: Homeopathy by the Commons Science and Technology Committee | H.Blog: Homöopathie & Forschung schreibt:
    31st.März 2010 um 11:02

    [...] That’s how lobbying works: Edzard Ernst and the “Evidence Check 2: Homeopathy” (UK House of Co… [...]

  5. edzard ernst schreibt:
    5th.April 2010 um 12:42

    sie sollten schleunigst etwas gegen ihren verfolgungswahn tun!

  6. Neuraltherapie.Blog schreibt:
    10th.April 2010 um 12:14

    Herr Ernst,

    bleiben Sie doch einfach sachlich, konstruktiv und gehen Sie auf die Logik der Argumente ein.

    Ihre Aussage …

    „Probably, the review by Shang et al [2] has been criticised by homeopaths. While no review can ever be without limitations, these criticisms have been refuted. If needed, I can provide further written evidence on this issue.“

    … ist eine Farce und Frechheit gegenüber Ihrem FK-Kollegen R. Lüdtke. Lüdtke und Rutten haben die Arbeit professionell als fehlerhaft widerlegt. Sie erhielten von den Autoren (Egger, Shang und Kollegen) keinen öffentlichen Widerspruch. Und Sie verschlüsseln dies kryptisch als “criticised by homeopaths”?

    Wenn Sie so dick und dreist austeilen, dann müssen Sie auch etwas Kritik einstecken können.

  7. Alters-Starrsinn? Edzard Ernst und ein peinliches Interview mit dem DZVhÄ | H.Blog: Homöopathie & Forschung schreibt:
    5th.Mai 2010 um 10:39

    [...] die Kontrollarbeiten von Rutten, Stolper und Lüdtke (→ Seltsames Gutachten zur Homöopathie; → That’s how lobbying works). Seriös wäre es gewesen, wenn Ernst die Kontrollarbeiten von Rutten, Stolper und Lüdtke [...]

  8. Chiropracticlive.com schreibt:
    10th.Mai 2010 um 17:00

    [...] Ezard Ernst is blaming Prince Charles for costing him his job? Seems Ernst can dish it out, but not so good at taking it. fed up on April 30, 2010 at 10:56 am http://www.neuraltherapie-blog.de/?p=1620 [...]

  9. Edzard Ernst im H.Blog? Respekt! | H.Blog: Homöopathie & Forschung schreibt:
    17th.Mai 2010 um 09:41

    [...] That’s how lobbying works: Edzard Ernst and the “Evidence Check 2: Homeopathy” (UK House of Co… und [...]

  10. scepticsbane schreibt:
    6th.September 2010 um 16:41

    Der “experte” der war NICHT ein experte!!

    Edzard Ernst EXPOSED:

    http://www.hmc21.org/#/edzard-ernst/4543212059

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