Gerry Dendrinos is interviewed by Alan V. Schmukler. Gerry works as a Classical Homeopath and Western Herbalist and serves as Vice President of the Australian Homoeopathic Association (AHA). He spent eighteen months investigating the NHMRC negative report on homeopathy, that was used to undermined homeopathy. In this interview, he exposes the misconduct and ethical breaches that the NHMRC engaged in to contrive its specious report.
A note from Gerry: The Australian homeopathic community is calling on the support of the homeopathic community internationally. We need your help to bring attention to the misconduct involved in the National Health & Medical Research Council Homeopathy Review published in 2015. This is negatively impacting homeopathy everywhere.
We are asking two things of our friends and colleagues internationally: First, go to www.yourhealthyourchoice.com.au and sign up – signing up takes only 30 seconds and is easy. If you are from outside Australia, just click the box that states: “I live outside of Australia”. Second, please donate even a small amount to the campaign, to help the Australian Homoeopathic Association (AHA) bring justice to this issue. https://www.yourhealthyourchoice.com.au/campaigns/donate/ Running such campaigns is expensive for a small association such as the AHA, but together we can make a big difference for homeopathy everywhere.
Gerry Dendrinos –
AS: How did the NHMRC decide to do a review of the evidence for homeopathy?
GD: The story of the National Health & Medical Research Council (NHMRC) Homeopathy Review starts with the 2009 UK House of Commons Science & Technology Report (Evidence Check 2: Homeopathy). The UK report was a political, not scientific report and the UK Parliament rejected its recommendations in July 2010 in favour of user-choice.
In October 2010, the then NHMRC CEO, Prof Warwick Anderson, instructed NHMRC Council to develop a formal position statement on homeopathy on the sole basis of the UK report – without critically evaluating it, consulting any homeopathy subject or research experts, or independently assessing any research evidence. The same month, Prof Anderson submitted an article to the Medical Journal of Australia in which he declared his personal stance that homeopathy was a “retreat from reason” and an “alleged therapy”. Open anti-homeopathy bias and lack of procedural and scientific rigour was evident from the start of the process.
AS: As I recall, the NHMRC’s draft position statement was that homeopathy was ‘unethical’, ‘inefficacious’, implausible’. They betrayed their clear bias from the start. Can you elaborate on this?
GD: In December 2010, NHMRC Council approved the content of a draft position statement on homeopathy, which declared homeopathy to be “unethical”, “inefficacious”, “implausible” and “placebo”; it even declared the prescribing of homeopathy to be “deceptive”. The statement was strongly adversarial and no evidence was assessed and no homeopathic experts were consulted in coming to this ‘position’.
NHMRC then contracted a consumer group containing prominent Skeptics to conduct a “readability check” – to check the wording (not the content) so the public would understand the statement when released.
On the morning of 20 April 2011 the Australian Homoeopathic Association (AHA) accidentally learned of the existence of the draft statement: that afternoon it was leaked to the media. It appears anti-homeopathy advocates within the NHMRC’s network were anxious that it be released, in case AHA’s inadvertent discovery of the process created unwanted controversy. Indeed, controversy over bias and lack of procedural and scientific rigour engulfed NHMRC, causing it to abandon the draft statement process. It was at this point that NHMRC decided to instigate a formal evidence review on homeopathy, to substantiate development of a formal position statement. So one could say that things did not get off to a promising start, with clear bias and opposition to homeopathy apparent throughout the process, from the top down.
AS: What happened next? Did biases and conflicts continue to influence NHMRC’s approach?
GD: To oversee the Review, in mid 2011 the NHMRC CEO personally selected and appointed four members to a ‘reference group’, which later became the Homeopathy Working Committee (HWC) when the Review formally commenced in April 2012. The NHMRC CEO refused to appoint any homeopathy subject or research experts to the HWC, in breach of NHMRC’s own mandatory guidelines, while also ignoring strong protest. This was despite a key criticism of NHMRC’s earlier draft statement process being the refusal to involve any homeopathy experts. History was repeating itself.
During this time, in July 2011, the NHMRC Chairman declared in an interview with the Australian Skeptics: “Let me assure you I am no supporter of homeopathy. As Chairman of NHMRC I can also assure you that NHMRC does not support homeopathy”. This was well before any evidence was assessed and it confirmed the bias.
Then in January 2012 a HWC member, Prof Peter Brooks, formally joined the anti-homeopathy Skeptics group ‘Friends of Science in Medicine’ (FSM), but he did not declare his conflict of interest.
In February 2012, the NHMRC CEO was personally warned of FSM’s attempts to influence NHMRC reviewers by an external party. Despite this warning, the CEO proceeded to appoint Prof Brooks as the initial Chair of the HWC – a fact NHMRC never declared for the duration of the Homeopathy Review.
In fact, NHMRC took no action at all on this conflict until mid-way through a first review of homeopathy it commissioned in 2012. Despite the conflict, NHMRC allowed Prof Brooks to remain on the HWC for the duration of the Review, without formally managing the conflict. Prof Paul Glasziou was appointed as the second Chair of the HWC.
AS: You mention that NHMRC did a ‘first’ review. Can you tell us more about this?
GD: Our investigation has revealed that between April and August 2012, NHMRC commissioned a first review of the evidence on homeopathy under a highly respected and experienced reviewer who had worked with NHMRC conducting evidence reviews for many years. This reviewer was even a principal author of NHMRC’s own guidelines on how to review health evidence. They had conducted and published multiple reviews using the seminal NHMRC method they co-developed.
However, NHMRC concealed the existence of this review, its findings and tax payer expenditure – as if it never existed! This raises serious questions concerning administrative and scientific misconduct. What does the NHMRC have to hide? We learned through Freedom of Information (FOI) documents that the reviewer’s contract was prematurely terminated within days of submitting their final Draft Report in early August 2012. These have also revealed that the first review was of good methodological quality. For example, in mid July 2012 a HWC member provided NHMRC with the following expert review of the reviewer’s work:
”Overall, the consistent use and reporting of the same criteria for each of the evaluations is a strength and reveals the careful systematic approach that has been brought to these evaluations. […] Overall, a lot of excellent work has gone into this review and the results are presented in a systematic, unbiased and convincing manner.”
Yet NHMRC terminated the reviewer’s contract just two weeks later.
AS: Why do you think the NHMRC would have terminated and concealed this report, especially given the reviewer completed the work and it received positive expert feedback regarding its quality?
GD: The NHMRC has refused to provide any details about the first review, but our investigation has revealed it almost certainly reported positive, good quality research for homeopathy in a number of medical conditions. Most disturbing, it appears this was a primary factor influencing NHMRC’s decision to terminate the reviewer’s contract. Based on explicit bias demonstrated in the process, it appears NHMRC was ideologically opposed to allowing the reporting of any positive research for homeopathy. Allowing this would in effect be an admission by Australia’s peak medical research institute that homeopathy is not only ‘plausible’, but it can be ‘efficacious’ – a fact well known to the international homeopathy community and the hundreds of millions of people that regularly use it.
NHMRC’s demonstrated bias and strong connections with the medico-skeptics community, members of which it directly involved in the Review, represented a fundamental conflict that impacted the objectivity of the process.
AS: So the final report that NHMRC published in March 2015 concluding there was “no reliable evidence” homeopathy works was conducted by another contractor?
GD: That’s right. After sacking the first reviewer – under suspicion of improper purpose (because they reported positive research evidence for homeopathy) – in October 2013 the NHMRC started again under a second contractor, Optum Insight. This was the Review published in 2015.
What happened next was perhaps even more controversial than what had occurred to date. Our investigation has uncovered the lengths to which NHMRC went to essentially engineer the final conclusion of “no reliable evidence” and in the process, breaching accepted standards of ethical administrative and scientific conduct. The seriousness of this issue is accentuated by the fact that the NHMRC is not Big Pharma – it is a taxpayer funded, government institution. Therefore, it not only has to demonstrate adherence to ethical scientific standards, but also is legally obliged to uphold standards of ethical administrative conduct.
AS: Could you explain the concept of “reliable evidence”?
GD: The NHMRC Review concluded, ‘there is no reliable evidence that homeopathy is effective in any health condition’, on the basis that there was ‘no good-quality, well-designed studies with enough participants for a meaningful result’. This conclusion largely rests on two criteria, that for a trial to be “reliable” it had to: 1) have more than 150 trial participants and 2) be rated 5 out of 5 on the ‘Jadad’ quality rating scale or equivalent on other scales (that is, ‘100% quality’). NHMRC also incorporated other criteria, such as a unique “modified GRADE” tool to assess the ‘level of confidence’ in the results. These are concepts most people would not understand or know how to question. At face value, the concept of “reliable evidence” appears reasonable, until one realises that the concept and its component criteria are 100% arbitrary! This is why the framework has never been used before or since by any other research group in the world, including NHMRC. It was developed specifically for the Homeopathy Review. But it is the story of how and when the framework was developed that tells a disturbing story, one that indicts the NHMRC for misconduct.