ADMINISTRATIVE REPORT

NHMRC advice on the effectiveness of

homeopathy for treating health conditions

March 2015

Publication Details
Publication title: Administrative Report: NHMRC Advice on the effectiveness of homeopathy for treating
healthconditions
Published:

March 2015

Publisher:

National Health and Medical Research Council

NHMRC Publication reference:

CAM02B

Online version:

www.nhmrc.gov.au/guidelines-publications/cam02

ISBN Online:

978-1-925129-30-4

Suggested citation: National Health and Medical Research Council. 2015

Administrative Report: NHMRC Advice on the effectiveness of homeopathy for treating
healthconditions. Canberra: National Health and Medical Research Council; 2015

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Commonwealth of Australia 2015
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ADMINISTRATIVE REPORT
NHMRC ADVICE ON THE EFFECTIVENESS OF HOMEOPATHY FOR TREATING HEALTH CONDITIONS

Administrative Report: NHMRC Advice on the

effectiveness of homeopathy for treating health
conditions

This administrative report refers to the development of the following documents:

Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions;
NHMRC Statement on Homeopathy; and
Background documents relating to the assessment of the evidence on the effectiveness of
homeopathy for treating health conditions.

Background
Within our health system there are a number of products and practices that are based on little or no
evidence of benefit beyond that of the placebo effect. There is a risk that patients may be misled into
rejecting practices and treatments that are proven to be effective for those that have no evidence to
substantiate the health claims they promote.
The NHMRC Strategic Plan 20102012 identified examining alternative therapy claims as a major
health issue for consideration by the organisation. This was broadened in the NHMRC Strategic
Plan 2013-15 to Claiming benefits for human health not based on evidence. NHMRC aims to provide
practitioners and patients with evidence based health advice on the effectiveness of a number of
Complementary and Alternative Medicines (CAM). Homoeopathy was the first CAM selected as it is
commonly used, both in Australia and around the world and its underlying premise is not consistent
with our current understanding of the biological, physiological and pharmacological sciences.
In late 2012, NHMRC commissioned an independent assessment of the evidence of effectiveness
for homeopathy to treat clinical conditions. The Information Paper: Evidence on the effectiveness
of homeopathy for treating health conditions provides a summary of this evidence. The NHMRC
Statement on Homeopathy was prepared on the advice of Council, based on the evidence provided
in the Information Paper. Both documents are defined as advise the community asper section
7(1)(a) of the NHMRC Act 1992. They have been developed for the Australian community, health
professionals and policy makers to guide healthcare choices, guide clinicalpracticeor influence
policy.
The documents were finalised in early 2015 following consideration by the Council of NHMRC.

Contributors
Homeopathy Working Committee
The Homeopathy Working Committee (HWC) was established in April 2012 and includes researchers
and experts in clinical trials, evidence-based medicine, complementary and alternative medicine and a
consumer representative. The role and functions of the HWC was guided by its Terms of Reference.

ADMINISTRATIVE REPORT
NHMRC ADVICE ON THE EFFECTIVENESS OF HOMEOPATHY FOR TREATING HEALTH CONDITIONS

Terms of Reference

The Homeopathy Working Committee will guide the development of a review of the literature
addressing the effectiveness of homeopathy (the Homeopathy Review) by providing advice to the
Office of the NHMRC on:
methods to identify relevant published guidelines, systematic reviews, government reports
andevidence submitted by relevant bodies; and
methods to evaluate relevant published guidelines, systematic reviews, government reports
andevidence submitted by relevant bodies.
The Homeopathy Working Committee will consider the outcomes of the Homeopathy Review
andusethese findings to inform the development of:
an Information Paper on homeopathy; and
a Position Statement on homeopathy, for consideration by NHMRC Council.
The Homeopathy Working Committee will advise on the Homeopathy Review, Information Paper
andPosition Statement for NHMRCs Health Care Committee, before recommendation to Council.
The Homeopathy Working Committee is effective from 2 April 2012 and appointments were originally
scheduled to conclude on 30 June 2013. Appointments have been extended to 2 April 2015. The
Homeopathy Working Committee will report to NHMRCs Health Care Committee.
Membership

The HWC comprised experts in includes researchers and experts in evidence-based medicine
andcomplementary medicine.
Member

Area of expertise

Chair
Professor Paul Glasziou MBBS, PhD, FRACGP

General practitioner; Professor and Director of the Centre for Research

into Evidence-Based Practice, Bond University, Queensland; Expert in
evidencebased medicine.

Professor Peter Brooks AM, MBBS, MD (Lund),

FRACP, FAFRM, FAFPHM, MDHonCausa, FRCP
(Glas, Edin)

Rheumatologist; Director of the Australian Health Workforce Institute,

University of Melbourne, Victoria (to September 2013); Executive Director
Research, Northern Hospital, Epping, Victoria; Former board member,
Australian Centre for Complementary Medicine Education and Research,
University of Queensland.

Professor Frederick Mendelsohn, AO, MB BS,

PhD, MD, FRACP

Neuroscientist; Former Chair in Medicine and Director of the Howard Florey

Institute, University of Melbourne, Victoria.

Dr Nikolajs Zeps, BSc(Hons), PhD:

Research scientist; Director, St John of God Subiaco Hospital Research

network; Adjunct Professor School of Health Sciences, Curtin University;
Adjunct Professor, Centre for Comparative Genomics, Murdoch University;
Adjunct Associate Professor, School of Surgery and School of Pathology
and Laboratory Medicine, University of Western Australia; Adjunct Associate
Professor, Faculty of Medicine, University of Notre Dame, Western Australia;
Founding Director, Australian Clinical Trials Alliance; Member, Research
Committee, NHMRC; Member, Australian Health Ethics Committee, NHMRC
Triennium 20102012.

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NHMRC ADVICE ON THE EFFECTIVENESS OF HOMEOPATHY FOR TREATING HEALTH CONDITIONS

Member

Area of expertise

Associate Professor Evelin Tiralongo,

BPharm(Hons), PhD, GradCertHigherEd

Pharmacist; Discipline head for complementary medicine teaching and

research, School of Pharmacy and Griffith Health Institute, Griffith University,
Gold Coast, Queensland; Member, Clinical Trials Coordinating Centre,
Griffith University; Member, Society for Medicinal Plant and Natural Product
Research.

Mr John Stubbs, BA, DipAcct

Consumer; Executive Officer, canSpeak; Honorary Associate, School of

Medicine, University of Sydney, New South Wales; Member, Australian
Health Ethics Committee, NHMRC; Member, Consumer Consultative Group,
NHMRC.

Professor Chris Baggoley, AO, BVSc(Hons),

MBBS, BSocAdmin, FACEM, FIFEM
(MemberMay 2012March 2013.
ObserverMarchJune 2013)

Australian Government Chief Medical Officer.

Declaration of conflict of interest process

Members of the HWC were required to declare their interests in writing prior to appointment,
inaccordance with NHMRCs Declaration of Interest policy.
Members were reminded of their obligation to consider any interest that may have arisen since the
last meeting or with any particular agenda items at every meeting of the HWC. A record of interests
was managed by the Office of NHMRC and updates were made to the NHMRC website as required
which is available at www.nhmrc.gov.au/health-topics/complementary-medicines/membershiphomeopathy-working-committee.
Declared Interest

Actions/Management strategy

Professor Peter Brooksmember of Friends

of Science in Medicine (from January to
April2012).

Stepped down as Chair of HWC.

Previously involved in establishing the Australian Centre for Complementary
Medicine Education and Research at the University of Queensland, in
association with Southern Cross University.
No formal management plan implemented.

Decision making process

A consensus based approach was used for developing the key evidence statements of the Information
Paper. All discussions were robust and open with decision-making being majority-based.
One member of the HWC recorded a dissenting view regarding the absence of a homeopath on
thecommittee. This was not supported by either NHMRC or the remaining committee membership,
for the following reasons:
The composition of committees for clinical guidelines is different from the composition of
committees for Health Technology Assessments (HTA). Clinical guideline working committees
typically include representatives from the target clinical disciplines that will use the final guideline.
In contrast, HTA committees typically include experts in research methods and technical fields, who
need not be experts in the particular branch of medicine in which the technology will be used.
This approach is consistent with other HTA committees such as the Medical Services Advisory
Committee, the Pharmaceutical Benefits Advisory Committee (PBAC) and the Therapeutic Goods

ADMINISTRATIVE REPORT
NHMRC ADVICE ON THE EFFECTIVENESS OF HOMEOPATHY FOR TREATING HEALTH CONDITIONS

Administration Statutory Advisory Committees. (NB: Whilst several PBAC members are clinicians,
they are not selected to match the discipline in which a medicine will be used, rather they are
selected for their expertise in assessing risk/benefit etc).
The purpose of NHMRCs assessment of homeopathy was to find and interpret evidence for
whether or not homeopathic medicines are effective not to develop a clinical guideline for
practising homeopaths.
Meetings

The HWC met once face to face and three times by teleconference in 2012 to discuss the scope
of the project and the assessment of the evidence. In 2013, two face to face meetings and seven
teleconferences were held to consider: the results of the evidence review; methodological review
comments; the criteria for developing the evidence statements; and the draft Information Paper.
Following release of the draft document for public consultation from 9 April 2014, the HWC met on
30 July to discuss additional evidence along with public consultation and expert review comments.
Two subsequent teleconferences were held to finalise the Information Paper and related documents.

NHMRC Project Team

The project was undertaken by a small team within the Environmental Health and Complementary
and Alternative Medicines Section of Research and Operations Group.

Assessment of the Evidence

The NHMRC assessment of the evidence utilised a combination of three main sources of information
about the effectiveness of homeopathy:
an evidence review (the overview of systematic reviews), comprising a systematic review of
published systematic reviews (summarised in the Overview Report)1;
evidence provided by homeopathy interest groups and the public at the beginning of the
process,before the commissioned overview of evidence (preliminary submitted literature)2
and during following public consultation on the draft Information Paper (public consultation
submittedliterature)3; and
evidence-based clinical practice guidelines, government reports on homeopathy published in other
countries, and other reports.
The assessment of the evidence is presented in three documents: the Overview Report, a systematic
review of available systematic reviews (an overview) on the effectiveness of homeopathy in treating
a range of clinical conditions in humans; the Review of Submitted Literature, a review of evidence
submitted to NHMRC from homeopathy stakeholder groups and members of the public prior to the
commencement of the evaluation; and the Review of Literature from public submissions, a review
of evidence submitted to NHMRC from homeopathy stakeholder groups and members of the public
during public consultation on the draft Information Paper.

Effectiveness of Homeopathy for Clinical Conditions: Evaluation of the Evidence

(OverviewReport)
In October 2012, NHMRC commissioned OptumInsight (Optum) to conduct a review to summarise
theevidence from systematic reviews regarding the effectiveness of homeopathy as a treatment
for any clinical condition in humans. The approach, of using published systematic reviews, was
recommended as an effective way of identifying the body of evidence for homeopathic treatments.

ADMINISTRATIVE REPORT
NHMRC ADVICE ON THE EFFECTIVENESS OF HOMEOPATHY FOR TREATING HEALTH CONDITIONS

The scope and parameters of the assessment was guided by NHMRCs HWC.
The methodology used to conduct the review was based on that described in Chapter 22 of the
Cochrane Handbook of Systematic Reviews of Interventions. Optum sought to identify systematic
reviews of studies that compared homeopathy with no homeopathy, or with other treatments
(prospective, controlled studies), and measured effectiveness in patients with any health condition.
Literature addressing the use of homeopathy for preventative/prophylactic use and in conjunction
with other therapies, where the design of the study confounds the results (i.e. where the specific
effect of homeopathy cannot be determined) was considered out of scope.
Literature searches were performed to identify all relevant systematic reviews of controlled clinical
trials of homeopathy in humans published in English between January 1997 and 3 January 2013.
Atotal of 57 systematic reviews were identified that met the criteria for inclusion within this Overview
Report. The reviews examined the evidence for a total of 68 clinical conditions and included seven
clinical conditions for which no relevant primary studies were identified.
From each included systematic review, data was extracted from the individual studies included in
the review by a single reviewer and checked by a second reviewer. In addition, the quality of each
included systematic review was assessed using the AMSTAR measurement tool by a single reviewer
and checked by a second reviewer. The overall conclusion of the systematic review authors was also
recorded. The evidence for each clinical condition was summarised and evidence statements were
formulated after consultation and agreement with the HWC. Full details are provided at
www.nhmrc.gov.au/health-topics/complementary-medicines/homeopathy-review.

Effectiveness of homeopathy for any clinical condition: evaluation of the evidence

Review of submitted literature
Interest groups and the public provided a total of 343 articles on homeopathy prior to the
commencement of the overview. The independent contractor, Optum, used similar methods of
assessment to that of the overview, whereby only prospectively designed and controlled studies
conducted in humans (including randomised controlled trials, pseudo-randomised controlled trials,
non-randomised controlled trials and prospective cohort studies) were considered.
A review of titles and abstracts found 234 articles were of the wrong research or publication type
and79 articles had already been included or considered in the overview. On application of the
inclusion criteria to the remaining 30 articles a total of nine studies were identified for critical
appraisal. Full details are provided at www.nhmrc.gov.au/health-topics/complementary-medicines/
homeopathy-review.

Effectiveness of homeopathy for clinical conditions: evaluation of the evidence

Review of evidence from public submissions
NHMRC commissioned a professional research group (Australian Research Centre for Health of
Women and Babies [ARCH]) to assess studies submitted during public consultation that had not
already been included in the overview.
During public consultation, 153 articles were provided by consumers, consumer groups, health
care professionals, homeopathy practitioners and homeopathy organisations. 94 articles were
excluded because they did not meet criteria for the NHMRC review (e.g. they did not investigate
treatment of health conditions in humans, they had already been considered in an earlier stage
of the NHMRC review, or they were not published studies). The remaining 58 studies, which had
not been included in the overview report or preliminary submitted literature report, were assessed
against predetermined criteria for consideration. After this assessment, 17 more of these studies were

ADMINISTRATIVE REPORT
NHMRC ADVICE ON THE EFFECTIVENESS OF HOMEOPATHY FOR TREATING HEALTH CONDITIONS

excluded because they did not meet the inclusion criteria. A total of 40 published studies assessing
the effectiveness of homeopathy for the treatment of health conditions were examined in detail.
For each study, the ARCH reviewers assessed the risk of bias systematically using a standardised
method (the Cochrane Collaborations tool for assessing risk of bias) and analysed the study results.

Independent methodological review

The Australasian Cochrane Centre conducted an independent Methodological Review of the
OverviewReport and its supporting documents to confirm that an appropriate and rigorous
approachhad been taken.
Optum considered all the reviewers comments and suggestions in consultation with the HWC,
and amended the report accordingly to ensure there was transparency in the processes used for
identifying and considering the evidence.

Development of the Information Paper

The Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions
provides Australians with a summary of evidence from research on the effectiveness of homeopathy
in treating health conditions in humans. The Information Paper explains how NHMRC considered
the findings of the assessment of the evidence in forming its conclusions. This work was guided
bytheHWC.
Technical writing of the Information Paper was contracted by the Office of NHMRC to Meducation.

Public consultation
A public consultation process on the draft Information Paper was undertaken from 9 April2 June
2014. The independent systematic review of the evidence and the review of submitted literature
undertaken by Optum were released at the same time as background information.
A media release was issued by NHMRC on 9 April 2014 and information on the public consultation
process was provided on the NHMRC website. Invitations were also sent to various key stakeholders.
The public was invited to provide comment of the clarity of the draft Information Paper and the
how the evidence was reviewed and interpreted by the HWC. Submission of any additional evidence
was also sought. In order for any additional evidence to be considered, the following criteria were
required to be met:
be a prospectively designed and controlled study (including randomised controlled trials,
pseudorandomised controlled trials, non-randomised controlled trials or prospective cohort
studies) OR a systematic review of prospectively designed and controlled studies;
be publicly available in English;
include participants with a particular clinical condition;
evaluate the effectiveness of homeopathy for the treatment of that clinical condition or
thetreatment of the clinical side effects of another intervention;
include a comparison group (placebo, no homeopathy or other treatment); and
report on clinically relevant outcomes.
A total of 48 submissions were received from consumers, consumer groups, health care professionals,
homeopathy practitioners and homeopathy organisations. The evaluation of the 153 citations

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NHMRC ADVICE ON THE EFFECTIVENESS OF HOMEOPATHY FOR TREATING HEALTH CONDITIONS

submitted is discussed in Effectiveness of homeopathy for clinical conditions: evaluation of the

evidence. Review of evidence from public submissions, available at www.nhmrc.gov.au/guidelinespublications/cam02.
In considering the feedback received during public consultation, a number of key themes/common
issues were identified across many of the submissions. The HWC developed a series of Frequently
Asked Questions (FAQs) to address these. The feedback from public consultation informed the
further development of the draft Information Paper. A summary of those considerations and the FAQ
document, can be found at www.nhmrc.gov.au/guidelines-publications/cam02.
Submissions from respondents who agreed to have their submission published (in full or redacted
where necessary), are available on the NHMRC Public Consultation website at http://consultations.
nhmrc.gov.au.

Independent Expert Review

Three experts (two Australian and one international) in the fields of complementary medicine
research and evidence based medicine provided comment on the draft Information Paper to ensure
that the evidence had been appropriately interpreted and synthesised. Expert reviewers were required
to declare any interests as per NHMRC standard processes.
The feedback from expert review informed the further development of the draft Information Paper.
Asummary of those considerations can be found at www.nhmrc.gov.au/guidelines-publications/
cam02.

Development of Statement
In response to its Terms of Reference, the HWC guided the assessment of the evidence on the
effectiveness of homeopathy and interpreted its findings in developing the Information Paper.
The NHMRC Statement was considered by Council, out of session in December 2014 and again in
March 2015 and was finalised in early 2015. The Statement provides advice to the community and to
policy makers, utilising evidence from the Information Paper.

Governance
Throughout the project, the HWC provided advice to Council and the Chief Executive Officer (CEO)
of NHMRC through the Health Care Committee (HCC). The final Information Paper and key themes
for the Statement were considered by HCC, out of session in November 2014 and by Council at its
meeting on 27 November 2014. Further consideration of the Statement by Council occured, out of
session, in early December 2014, and in March 2015.
Council has a broad range of experience and expertise in health and medical research as well as
consumer issues. Councils final approval and recommendation to the CEO ensures that material
issued by NHMRC is evidence-based, robust and meets international standards.
The CEO agreed to issue the Information Paper and Statement under Section 7(1)(a) of the
NHMRCAct in March 2015.

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NHMRC ADVICE ON THE EFFECTIVENESS OF HOMEOPATHY FOR TREATING HEALTH CONDITIONS

References
1 Optum. Effectiveness of homeopathy for any clinical condition: evaluation of the evidence. Overview report.
Canberra: NHMRC; 2013.
2 Optum. Effectiveness of homeopathy for any clinical condition: evaluation of the evidence. Review of submitted literature.
Canberra: NHMRC; 2013.
3 Australian Research Centre for Health of Women and Babies. Effectiveness of homeopathy for clinical conditions: evaluation of the evidence.
Review of evidence from public submissions. 2014

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