Program for Evaluating Complementary Medicine
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In 1998, the Swiss government began a comprehensive Program for Evaluating Complementary Medicine, or PEK, to study the role and effectiveness of complementary medicine, which were playing an ever-increasing role in the Swiss medical system.
The results were, for the government, surprisingly positive towards complementary medicines. As a result:
- A conference scheduled for April 2005 to present and discuss the results of the PEK study was cancelled because the National Health Office allegedly suppressed the publication of the study data.
- Some collaborators were allegedly coerced into deleting all PEK related data from their computers.
- A final meeting of the international Review Board of 6 professors from Switzerland, Germany, Denmark and the UK – responsible for the scientific quality of the PEK study – to be held in June 2005 for a final assessment of the project, was cancelled.
- 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.
The government had declared that the results of the study would determine which complementary medicines, if any, would continue to be supported by the national insurance program in Switzerland. The study concluded that three of the five approaches studied were both therapeutically and cost-effective and should continue to be supported. Before the study was concluded, however, the government announced that it would withdraw support for all complementary approaches to medicine. It also removed the recommendation that the three approaches continue to be supported from the official document it released.[1]
Considerable uproar followed, including protests from many scientists involved in the study (including the scientific director of the program) about political interference in the scientific process.
- "The international review board of PEK has publicly protested at political interference in the scientific process: ‘There is a consensus among the review board members that the final PEK process deviated from what would have been expected by conventional standards.'"[2]
As a result, the Swiss government allowed some reports to be put onto the health ministry (BAG)'s website and the data files made available for perusal at the BAG office in Bern.
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[edit] PEK summary of the study
[edit] Background
Following the decision taken by the Federal Department of Home Affairs (DHA) on 9 July 1998, five complementary therapies - anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine (more precisely, [[traditional Chinese herbal therapy]]) - were included on 1 July 1999 for a limited period (until 30 June 2005) in the list of services covered by the compulsory health insurance scheme (KLV). These services are only eligible for reimbursement if they are provided by physicians who have the relevant proficiency certificates, issued by the Swiss Medical Association (FMH).
The decision on whether these complementary methods should be retained within the basic health insurance scheme is dependent on their efficacy, appropriateness and cost effectiveness being demonstrated. To this end, the [[Complementary Medicine Evaluation Programme]] (PEK) was carried out from 1998 to 2005.
[edit] Design of the PEK
A basic procedure was defined, comprising two parts. In Part 1 (evaluation of the provision of complementary medicine for patients in Switzerland), empirical studies were to be carried out, permitting conclusions as to:
(A) how prevalent the five therapies are in Switzerland, (B) which physicians offer these therapies, (C) which patients have recourse to them, (D) what results are achieved with these treatments, and (E) what impact these therapies have on costs.
For points b, c, and e, comparisons were made with conventional medicine. On account of methodological and time-related problems, however, point D could not be evaluated.
In Part 2 (literature analysis), the literature available internationally on efficacy, appropriateness (here primarily defined in terms of safety and utilization) and cost-effectiveness was to be systematically compiled and reviewed.
[edit] Results of the evaluation of the provision of complementary medicine for patients in Switzerland
In 2002, 10.6% of the Swiss population had recourse to at least one of the five complementary therapies, with homeopathy being the individual method most frequently mentioned.
Practitioners of complementary medicine can be distinguished from physicians providing conventional healthcare with regard to the nature, location and technical resources of their practice. The patients they treat tend to be younger, female and better educated. These patients tend to have a favourable attitude towards complementary medicine and to exhibit chronic and more severe forms of disease. Technical diagnostic procedures are performed more rarely, and patients’ wishes are taken into account more frequently in the choice of treatment. On average, the consultation lasts markedly longer than in conventional care.
Patients are more satisfied with the care provided in practices offering complementary medicine.
Side effects are reported by markedly fewer patients than with conventional care – with the exception of phytotherapy.
With complementary medicine, the total annual costs are markedly lower than the average for conventional care. Overall, however, complementary practitioners treat fewer patients, and more frequently younger and female patients. Adjusted for these factors, the total patient-related costs do not differ significantly from those for conventional care. The cost structure is characterized by a greater weighting for consultation costs and a lower weighting for drug costs. The actual increase in costs resulting from the inclusion of the five complementary therapies in Switzerland’s basic healthcare provision proved to be markedly lower than expected. On the basis of the statistics produced by the PEK, the question of whether complementary medicine should be regarded as being utilized in addition to or, rather, instead of conventional care cannot be definitively answered.
Results of the literature analysis
The analysis of the literature involved two different projects.
(1) For each of the five complementary therapies, a comprehensive overall evaluation (evaluation report) was prepared. (2) In addition, meta-analyses (systematic reviews including statistical evaluation of aggregated data) of placebo-controlled clinical studies were prepared for homeopathy, phytotherapy and traditional Chinese herbal therapy.
As regards the first project, the assessment of efficacy was favourable in all of the evaluation Reports. For phytotherapy and homeopathy in particular, this was based on the evaluation of published systematic reviews and randomized clinical studies. In the case of traditional Chinese herbal therapy, while numerous randomized studies of Chinese origin exist, they are scarcely available in Western countries.
In the view of the evaluation committee, the interpretation of the available evidence on efficacy in the evaluation reports appears to be overly optimistic for all of the methods reviewed, and especially for neural therapy. The safety of all five therapies is favourably assessed, with certain reservations in the case of neural therapy and traditional Chinese herbal therapy.
Data concerning utilization are only available for complementary medicine as a whole; for many countries, the uptake is shown to be high and still increasing.
As regards the second project, in the view of the authors of the meta-analyses, the available placebo-controlled studies on homeopathy do not demonstrate any clear effect over and above placebo. For phytotherapy, in contrast, a positive result is shown, as in the evaluation report, and for traditional Chinese herbal therapy an unequivocal assessment is not possible. Here, too, the validity of the conclusions of the meta-analyses should be regarded as limited from a methodological perspective.
