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I question the AIDS establishment. Join me!

Bias-binding and the PEKing order

“Research is subordinated (not to a long-term social benefit) but to an immediate commercial profit. Currently, disease (not health) is one of the major sources of profit for the pharmaceutical industry, and the doctors are willing agents of those profits.”
Dr Pierre Bosquet, Nouvelle Critique, France, May 1961

These days it’s hard not to conclude that the general public throughout the world are being thoroughly stitched up when it comes to the question of reliable information about health matters.

As a minor example, I happened to come across a 2005 study on mobile phone use and the incidence of acoustic neuroma (M J Schoemaker, A J Swerdlow, and others: Mobile phone use and risk of acoustic neuroma: results of the Interphone case-control study in five North European countries. British Journal of Cancer (2005), 1-7) which found a slight but statistically insignificant increase in incidence of acoustic neuroma related to mobile phone use based on 678 cases and 3553 controls in the UK and four Nordic countries over a period of 10 years. The study concludes “… that there is no substantial risk of acoustic neuroma in the first decade after starting mobile phone use. However, an increase in risk after longer term use or after a longer lag period could not be ruled out.” (emphasis added)

The study only looked at one particular type of cancer based on the assumption that acoustic neuroma would be the most likely cancer to develop from an EMF radiation source held close to the ear. Acoustic neuromas are rare, and the assumption that the effects of EMF radiation will only be visible closest to its source (given that EMF radiation is effective over considerable distances, hence its use in mobile phones!) in exactly that way is questionable. And of course a specific study of one type of cancer like this can’t in any way be extrapolated to all cancers.

Yet how did the “responsible” press headline this story?

BBC: Mobile phone cancer link rejected (30 August 2005)
The Guardian: Mobiles’ 10-year all-clear for cancer (31 August 2005)
The Independent: Using a mobile phone regularly does not cause cancer, scientists conclude (31 August 2005)
Reuters: No brain cancer link to mobile phones, study says (30 August 2005)

Never let truth stand in the way of a good story …

But at least we can be thankful that these headlines were only gross exaggeration, as opposed to the outright lies promulgated by The Lancet in claiming an end to homeopathy based on the meta-analysis by Shang et al published last August.

It emerges that the Shang et al meta-analysis was an offshoot from a Swiss government study, the Programm Evaluation Komplementärmedizin (PEK), which was designed to allow politicians to assess whether or not five complementary therapies – anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese herbal therapy – should be included in the list of services covered by the Swiss compulsory health insurance scheme (KLV). The cost of complementary therapies were, until 1998, reimbursed under the basic national scheme, but a change in the regulations in 1998 put the decision over which therapies were or were not valid for reimbursement in the hands of the Swiss Department of Internal Affairs (EDI). Public outcry forced the government to back-peddle and the five most popular therapies were reinstated in the KLV scheme from 1999 to 2005, on condition that each therapy was provided by FMH-certified physicians only, and that a simultaneous study in each therapy’s effectiveness was carried out (the PEK study). The decision on whether the therapies were retained within the basic health insurance scheme after 2005 would depend on the demonstration of their efficacy, appropriateness and cost effectiveness.

The study was set up under the Federal Office of Social Insurance (BSV) with a well-defined management structure and review board of internationally-acknowledged experts. It received widespread praise for the quality of its design and the degree of cooperation and transparency amongst its participants. As each area of the study began publishing their findings, the project was cited as an exemplar for future CAM research.

But as the extent of the findings in favour of the five therapies began to become clear, in 2004 PEK’s management structure was abruptly changed and the control of the study was passed to the Federal Office of Health (BAG). From that point onward, many attempts were made to interfere with and derail its emerging conclusions. Transparency was immediately compromised. Economic data showing the cost benefits of CAM were suppressed. The economist preparing to present the results of his work was dismissed without reason and placed under a gagging order. Other departments were prevented from publishing their work.

One member of the PEK steering committee, Dr med Peter Heusser, was so disgusted by what he witnessed that he has written an account of what happened, Medizin und Macht am Beispiel des Programms Evaluation Komplementärmedizin PEK (currently only available in German, but machine-translated here), and this brief summary is drawn largely from his account.

The Swiss authorities – both the government and the Federal Office of Health (BAG) – tried to sweep the PEK study under the carpet. A conference scheduled for April 2005 to present and discuss its results had to be cancelled because the Federal Office of Health prevented the publication of the study data. Some collaborators were even coerced into deleting all PEK-related data from their computers. The final meeting of the PEK international review board (six professors from Switzerland, Germany, Denmark and the UK responsible for the scientific quality of the study), scheduled for June 2005 for a final assessment of the project, was cancelled. (The review board eventually produced a summary report in September, which is highly critical of the political interference in the study.) Many contributors had their contracts terminated before their work could be completed. The recommendation in the final draft that homeopathy, anthroposophical medicine and herbal medicine should stay in the compulsory health insurance scheme was deleted in the final publication.

Review board member Harald Walach PhD protested:

“I protested on behalf of the international review board whose membership was against this highly unusual procedure. I had an interesting exchange of e-mails and letters with the vice-president of the Swiss federal health agency, which told me a lot about the irrelevance of scientific data in the face of political decisions. What I basically learned was that the data gathered by the researchers were absolutely irrelevant to the decision. The vice-president, in an e-mail to me, literally called the data “waste products which do not bear any relevance to the political decisions.” It is important to highlight this situation in the face of editorials and information in the public press, which seem to imply that the Swiss decision was based on evidence about the higher costs and ineffectiveness of complementary medicine. Very likely, the opposite was true: The data probably suggested some cost effectiveness and they certainly did not imply zero effectiveness. But this information was held back from the public in order to veil the political nature of the decision, I assume.”

Walach concludes his editorial,

“This is a very interesting, informative, and, in fact, very sobering piece of recent history in the evaluation of complementary medicine. Public authorities, health systems researchers, and, in fact, all CAM researchers should at least take some note of this process in order to understand the complexities of the issues at stake and of the power-plays of different stakeholders in the game.”
(Walach, H. The Swiss Program for the Evaluation of Complementary Medicine (PEK). Journal of Alternative and Complementary Medicine, April 2006; Vol 12, No 3, pp 231-232)

The Swiss government pre-emptively decided to exclude all CAM therapies from the compulsory health insurance scheme as of 30 June 2005, effectively ignoring not just the weight of scientific findings and economic benefits (which could save SFr millions on the health budget) which were emerging from the still-to-be-completed PEK study, but also the weight of Swiss public opinion.

In this context, the appearance of the Shang et al meta-analysis in The Lancet two months later – notably pre-empting the final report from the PEK international review board – can do little else but appear even more biased and reverse-engineered than it does already in its own right (see Myths and Misconceptions). A letter to The Lancet from the Swiss Association of Homeopathic Physicians raising objections to the study was not even granted publication.

None of this – aside from the initial frenzy surrounding the announcement of the conclusions of the meta-analysis on homeopathy – appears to have raised so much as a whisper from the English-speaking international media.

Perhaps it’s worth noting that Switzerland is ranked as 8th most competitive nation in the 2005 World Competitiveness Yearbook. (In comparison, the UK came 22nd.) And it’s also ranked 8th in terms of the major exporting countries of chemical and pharmaceutical products. Around 5% of current global pharmaceutical R&D is attributable to Swiss companies. Since many university medical research laboratories would cease to exist without the support of the pharmaceutical industry, it’s perhaps no surprise that “at the end of 2004, professors of the medical faculties had expressed the intention at a meeting of the Swiss Academy of Medical Sciences … to do everything in their power to prevent complementary medicine remaining in the basic insurance. A dean voiced the prevailing opinion: “We must provide hand grenades [literal quotation, personal communication of a participant of that conference] against complementary medicine.”” (Dr med Peter Heusser).

On a more metaphysical note, it’s interesting too how the number 8 appears twice in the Swiss rankings (not to mention being the final ridiculously small number of homeopathic trials selected to represent the therapy in the Shang et al meta-analysis) given its numerological associations with executive character, political skills, handling of power and authority, working for a cause, command, ambition, lacking humanitarian instincts, repression and materialism … and itself a figure, in the form of the lemniscate, often connected with the maxim “as above, so below”.

More comment on this topic:
Dr Manish Bhatia

“The prerequisite for today’s medical policy is naturally the currently predominant system of medicine. The sick are the source of income, therefore it is necessary for sick people to be there, yes, it proves advantageous if one makes the people artificially sick.”
Dr med Steintl: ‘International Medical Policy’, 1938, Berlin

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One Response to “Bias-binding and the PEKing order”

  1. […] The Lancet prepares to publish another issue on homeopathy, this seems a suitable moment to republish a blog entry from 18 months ago which described the highly irregular context forming the backdrop to the publication of the […]

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