Homeopathy: Medicine for the 21st Century

Fifth Draft

On 29 July the ASA Ltd sent the fifth Draft Recommendation with an accompanying letter. In this version significant changes were made. Two further challenges were not upheld – for the reasons H:MC21 had pointed out months before. The number of references to the Evidence Check 2 was dramatically reduced, but without any explanation of the reasoning for including or excluding references. In defence of the ASA Ltd’s position, a completely new reference appeared to “a review of over 100 placebo controlled trials”. The reference was unattributed, but if it was to the discredited Shang meta-analysis, then, to be accurate, it should have read “a review of eight selected placebo controlled trials”.

On 4 August 2011 H:MC21 wrote to the Chief Executive of the ASA Ltd, raising a number of new and serious issues relating to the process of this investigation.

On 6 August 2011 H:MC21 also wrote to the investigation team pointing out that even if H:MC21 took up the offer of writing a supplementary submission to the ASA Council, it was not possible to address all the errors in the Draft Recommendation in the space permitted, and that these errors should be corrected in the Draft Recommendation.

The Chief Executive of the ASA Ltd replied on 19 August 2011 without addressing the specific issues raised by H:MC21.

The ASA investigation team replied on 22 August 2011 and agreed to make a single change. The ASA Ltd also stated that the reference to “a review of over 100 placebo controlled trials” was not to original evidence, but to a statement in the Evidence Check 2. The ASA Ltd also brought forward the date for submitting the supplementary document for the ASA Council.

H:MC21 wrote to the ASA Ltd on 25 August insisting that the original submission date be retained.

H:MC21 provided a two-page supplementary submission to the ASA Council on 5 September 2011.

Final Adjudication

On 23 September 2011 the ASA Ltd sent the final adjudication with an accompanying letter. Two more challenges were not upheld, again on the same grounds as H:MC21 had argued. A number of other changes were made which reflected H:MC21’s objections to the Draft Recommendation. The key objection that the ASA Ltd had created an argument against H:MC21’s evidence based on unscientific grounds was not addressed. The adjudication was published on 5 October 2011, nearly a year after the process started.

Appeal

On 14 October 2011 H:MC21 wrote to the Independent Reviewer of ASA Adjudications and appealed against the ASA Council’s decision, attaching 17 supporting documents. This was followed by the submission on 23 January 2012 of Gudrun Bornhöft and Peter Matthiessen (eds), Homeopathy in Healthcare – Effectiveness, Appropriateness, Safety, Costs: An HTA report on homeopathy as part of the Swiss Complementary Medicine Evaluation Programme, trans. from the German by Margaret M Saar (Berlin, Heidelberg, New York: Springer-Verlag, 2011). N.B. Correspondence between the ASA and the authors of the Swiss HTA is available on the Freedom4Health website.

On 16 February 2012 the Independent Reviewer informed H:MC21 of his interim report and the decision by the ASA Ltd to re-open the investigation. On 19 April the Independent Reviewer agreed to take the additional submission into account.

The ASA Ltd sent the first Draft Recommendation of the appeal process on 11 December 2012 with an accompanying letter, and required a response by 24 December 2012. H:MC21 pointed out on the 12 December 2012 that it was unreasonable to expect a response within 7 working days at such a time of year, without any warning having been given. The ASA Ltd replied the same day that it would look into an extension of the deadline and respond the next day, which it did not.

Two days later, on 14 December 2012, H:MC21 wrote to inform the ASA Ltd that its adviser would not be available to deal with the case immediately, and that the earliest they could respond would be the first week in February. On 17 December 2012 the ASA Ltd agreed a new deadline of 10 February 2013.

On 20 December 2012 H:MC21 asked for further information about historical complaints to the ASA over homeopathy. On 7 January 2013 the ASA Ltd replied that “the ASA had considered very few complaints relating to Homeopathy before the extension of our remit in 2011 to online marketing communications”. Two cases (both dating from 2006) were supplied which had been attached to this investigation. Case 1 addressed claims for specific conditions and practitioner qualifications, though neither issue was relevant to the H:MC21 case. In Case 2 the only claim relevant to the H:MC21 case was one that homeopathic medicines do not produce side effects. The ASA Ltd had upheld the challenge, though the same challenge was not upheld in the H:MC21 case.     Continues ...