Giving homeopathic remedies to patients on the NHS is unethical and a dubious use of public money, scientists and doctors told MPs today.ここに英国ホメオパシー協会(BHA)がホメオパシーに効果があると主張するドキュメントを提出したのだが、それがレビュー論文を歪めて引用したと批判されることになった。
The treatments, which are licensed by the government and offered through several NHS hospitals, have insufficient clinical evidence to support them, they said.
The criticisms were raised in an inquiry held by the Commons cross-party science committee to investigate the strength of scientific evidence behind government policy on homeopathic medicines.
"If the NHS commitment to evidence-based medicine is more than a lip service, then money has to be spent on treatments that are evidence-based, and homeopathy isn't," said Edzard Ernst, a professor of complementary medicine at the Peninsula medical school in Exeter.
NHS制度上で、ホメオパシーレメディを患者に投与することは非倫理的であり、公的資金の疑わしい使用であると、今日、科学者たちと医師たちが議会証言した。
政府に認可され、複数のNHS病院で提供されている治療法は、それを支持する十分な証拠がないと科学者たちと医師たちが証言した。
批判は、ホメオパシー医療について政府政策の根拠となる科学的証拠の強さについて調査する下院超党派科学委員会で開かれた公聴会で挙げられた。
「エビデンスベース医療に対するNHSのコミットメントがリップサービス以上のものだというなら、エビデンスベースの治療法に資金を使うべきであって、ホメオパシーはそうではない」とExeterのPeninsula medical schoolの補完医療の教授Edzard Ernsが述べた。
[Ian Sample: "Homeopathy on the NHS is unethical, doctors tell MPs" (2009/11/25) on The Guardian]
The British Homeopathic Association has been accused of misrepresenting scientific evidence on alternative medicine in documents it gave to a parliamentary inquiry.まず指摘されたのは以下の部分：
The organisation claimed several scientific reviews offered support for homeopathy in material submitted to the cross-party science and technology select committee, which is holding an investigation into the products. Robert Mathie, a researcher at the BHA, said the reviews found evidence for a difference between homeopathic remedies and sugar pills, which contain no active ingredients.
But the claim has dismayed some of the scientists who wrote the reviews and angered MPs on the committee who are in the final stages of writing their report.
英国ホメオパシー協会(BHA)は、議会公聴会に提出した、代替医療の証拠についてドキュメントで科学的証拠を歪めて引用したと批判された。
BHAは超党派科学技術特別委員会に提出したドキュメントにおいてホメオパシーを支持している科学的レビュー論文を複数挙げた。それらはホメオパシー製品を調査しているものだった。BHAの研究者Robert Mathieはホメオパシーレメディと有効成分のない砂糖玉の違いがあるという証拠を見出したレビュー論文だと述べた。
しかし、その主張は、レビュー論文を書いた科学者たちの一部を愕然とさせ、報告書執筆の最終段階にあった委員会の議員たちを怒らせた。
[Ian Sample:" Homeopathic society 'misled' MPs in inquiry" (2010/02/05) on The Guardian]
2 Systematic reviews of randomised controlled trials ランダム化対照試験の系統的レビューThe GuardianのIan Sampleによれば、これらのレビュー論文の著者たちは次のように反応している：
2.1 Comprehensive systematic reviews (all medical conditions with homeopathy research)
Four out of five comprehensive systematic reviews of RCTs in homeopathy have reached the qualified conclusion that homeopathy differs from placebo.1, 2, 3, 4 One of those four reviews also stated there was “insufficient evidence […] to draw conclusions about the efficacy of homeopathy for any specific medical condition”.4 The fifth systematic review concluded there was “weak evidence for a specific effect of homoeopathic remedies”;5 the methodology of that review and its conclusions have been challenged.6
ホメオパシーのランダム化対照試験の5本のレビュー論文のうち4本が、ホメオパシーはプラセボと差異があるという結論に条件付きで達した[1,2,3,4]。これらの4本のうち1本は「いかなる特定の医学的状態についてもホメオパシーの有効性を結論にするには証拠は不十分だ」と書いている[4]。5本目の系統的レビュー論文はホメオパシーレメディの特定の効果の弱い証拠があると結論している[5]。そのレビューの方法と結論は批判を受けた[6]。
1 Kleijnen J, Knipschild P, ter Riet G (1991). Clinical trials of homoeopathy British Medical Journal, 302: 316.323.
2 Boissel JP, Cucherat M, Haugh M, Gauthier E (1996). Critical literature review on the effectiveness of homoeopathy: overview of data from homoeopathic medicine trials. In: Homoeopathic Medicine Research Group, Report of the Commission of the European Communities, Directorate-General XII . Science, Research and Development, Directorate E . RTD Actions: Life Sciences and Technologies . Medical Research, Brussels, Belgium.
3 Cucherat M, Haugh MC, Gooch M, Boissel JP (2000). Evidence of clinical efficacy of homeopathy . A meta-analysis of clinical trials. European Journal of Clinical Pharmacology, 56: 27.33.
4 Linde K, Clausius N, Ramirez G, et al (1997). Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet, 350: 834.843.
5 Shang A, Huwiler-Muntener K, Nartey L, et al (2005). Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet, 366: 726.732.
6 Ludtke R, Rutten ALB (2008). The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. Journal of Clinical Epidemiology, 61: 1197.1204.
[Memorandum submitted by The British Homeopathic Association HO 12]
I spoke to Jean-Pierre Boissel, an author on two of the four papers cited (Boissel et al and Cucherat et al), who was surprised at the way his work had been interpreted. "My review did not reach the conclusion 'that homeopathy differs from placebo'," he said, pointing out that what he and his colleagues actually found was evidence of considerable bias in results, with higher quality trials producing results less favourable to homeopathy.以上の引用元のAbstractの記述は以下の通り：
The third of the four papers, Kleijnen et al, concluded that the data were "not sufficient to draw definitive conclusions". The fourth, published in 1997 by Linde et al, was updated two years later, and yet the update ? which was more critical of homeopathy ? was not cited.
Boissel pointed out an even more surprising error: that the two papers he was involved in were actually describing the same analysis. In other words, Mathie managed to take one study that the author emphatically maintains didn't support homeopathy, and present it as two studies that did. I asked Boissel whether he felt comfortable that his work was being presented to the public as evidence in favour of homeopathy. His response was simple: "Definitively no!"
引用された4本の論文のうち2本(Boissel et al; Cucherat et al)の著者のひとりであるJean-Pierre Boisselと話した。彼は自分のレビュー論文の解釈のされように驚いていた。「私のレビュー論文は、ホメオパシーとプラセボには差異があるという結論には到達していない。私と共著者たちが実際に見つけたのは、結果にバイアスのある証拠であり、クウォリティの高い実験をやれば、ホメオパシーに有利でない結果が出るだろうというものだった。
4本のうちの3本目のKleijnen et alは「確定的な結論を出すには不十分なデータ」だと結論していた。1997年に発表されたLinde et alは2年後にアップデートされ、よりホメオパシーに批判的になっていたが、これは引用されていなかった。
Boisselはさらにひどり誤りを指摘した。彼が関与した2本の論文は同じ分析を書いたものだ。言い換えるなら、著者たちがホメオパシーを支持しないという一つの研究をMathieが2つの研究として提示しようとしたものだ。私はBoisselに、自分の研究がホメオパシーの証拠して市民に提示されていたことについて、どう思うか質問した。Boisselの返答はシンプルなものだった「まったくノー!!」
[Homeopathic association misrepresented evidence to MPs (2010/02/04) on The Guardian Blog]
Cucherat et al: "Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group.",Eur J Clin Pharmacol. 2000 Apr;56(1):27-33.さらに、特定の医学的状態に注目したレビューとして挙げられたものにも同様の問題があった：
CONCLUSIONS: There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies. Further high quality studies are needed to confirm these results.
Kleijnen et al: "Clinical trials of homoeopathy", BMJ. 1991 Feb 9;302(6772):316-23.
CONCLUSIONS--At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials.
Linde et al: "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials", Lancet. 1997 Sep 20;350(9081):834-43.
INTERPRETATION: The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.
2.2 Systematic reviews focusing on particular medical conditionsこれらはIan Sampleによれば...
Five reviews concluded there was positive evidence for homeopathy(... post-operativeに ileus;8 ...)
8 Barnes J, Resch K-L, Ernst E (1997). Homeopathy for postoperative ileus? A meta-analysis. Journal of Clinical Gastroenterology, 25: 628?633.
2.3 Systematic reviews focusing on particular groups of diagnoses
There are seven systematic reviews in this category. Four of these reviews were positive (... rheumatic diseases27);
27 Jonas WB, Linde K, Ramirez G (2000). Homeopathy and rheumatic disease. Rheumatic Disease Clinics of North America, 26: 117.123.
[Memorandum submitted by The British Homeopathic Association HO 12]
The BHA's other evidence is also riddled with errors. Edzard Ernst, the author of a meta-study cited in favour of homeopathy, complained to me that, "they omitted the important caveats from our conclusions and therefore were grossly misleading in the interpretation of our data."以上2本のAbstractには次のような記述がある：
A review by Jonas et al concludes that there are "too few studies to make definitive conclusions about the efficacy of any one type of homeopathic treatment on any one condition" yet is cited by the BHA as providing evidence that homeopathy is effective in the treatment of rheumatic diseases.
英国ホメオパシー協会(BHA)が他に挙げた証拠も誤りだらけである。ホメオパシーを支持するものとして引用されたメタ分析研究の著者であるEdzard Ernstは私に「彼らは我々の結論から重要な警告を省略しており、我々のデータの解釈を大きくミスリードするものになっている。
Jonas et alのレビュー論文は「いかなる症状に対する、いかなるホメオパシー治療の有効性について確定的な結論を得るには研究が少なすぎる」と結論していたが、BHAはリウマチ性疾患の治療にホメオパシーが効果的だという証拠を提供する成果として引用している。
[Homeopathic association misrepresented evidence to MPs (2010/02/04) on The Guardian Blog]
Barnes et al: "Homeopathy for postoperative ileus? A meta-analysis",J Clin Gastroenterol. 1997 Dec;25(4):628-33この他にも、幾つかの誤りが指摘されている。
There is evidence that homeopathic treatment can reduce the duration of ileus after abdominal or gynecologic surgery. However, several caveats preclude a definitive judgment. These results should form the basis of a randomized controlled trial to resolve the issue.
Jonas et al: "Homeopathy and rheumatic disease.", Rheum Dis Clin North Am. 2000 Feb;26(1):117-23, x.
Despite a growing interest in uncovering the basic mechanisms of arthritis, medical treatment remains symptomatic. Current medical treatments do not consistently halt the long-term progression of these diseases, and surgery may still be needed to restore mechanical function in large joints. Patients with rheumatic syndromes often seek alternative therapies, with homeopathy being one of the most frequent. Homeopathy is one of the most frequently used complementary therapies worldwide.
おそらくホメオパシーに効果がないことがわかっていて、英国ホメオパシー協会は意図的に間違えた文献引用を行ったと思われる。
なお、本件に登場した補完医療のEdzard Ernst教授は、Simon Singhと共著で"Trick or Treatment"を執筆している。
タグ：Quackery
＞Edzard Ernst教授は、Simon Singhと共著で"Trick or Treatment"を執筆している。
これの邦訳が「代替医療のトリック」です。
http://www.amazon.co.jp/dp/4105393057/
そういえば、この"Trick or Treatment"というタイトルは40年前にサイコセラピーをネタにしたRichard B. Stuartの本のタイトルでもあったのですね...
http://www.amazon.com/dp/0878220526/