The government of Switzerland has bowed to popular pressure and decreed that state-backed health insurance must pay for five types of “complementary medicine” between now and 2017, pending an independent investigation of whether or not they work. Supporters of evidence-based medicine fear the process will confer credibility on dubious treatments.

Switzerland has 17,200 registered complementary practitioners, the most per head of population in the world. In 2009, 67 per cent of the electorate voted, under the country’s system of deciding issues by referendum, for five such therapies to be covered by health insurance. They are homeopathy, herbal and traditional Chinese treatments, anthroposophic medicine – which among other techniques uses mistletoe to treat cancer – and neural therapy, which is based on injecting local anaesthetics near nerve centres.

In December, however, the government’s scientific panel advised that this would be illegal, as the law requires insurance to pay only for treatments that meet objective measures of efficacy, and these techniques do not. Yet the government cannot ignore the referendum.

“The only legal solution was to pay for the five methods temporarily, but linked to an evidence-based evaluation,” says Ignazio Cassis, a member of the Swiss federal parliament and vice-chair of the Swiss Medical Association. “This isn’t science, it’s Swiss politics.”


From effect to benefit

The evaluation will be based on a report on existing studies of the techniques. This will be prepared by Swiss complementary practitioners and then reviewed by an independent institution, possibly the UK’s National Institute for Health and Clinical Excellence. Hansueli Albonico, head of the Swiss practitioners’ union, says 2000 studies have been done.

But they may not be the rigorously controlled trials normally required for medicines. Albonico told journalists that “we need a shift away from methods used for testing effectiveness, such as are appropriate for drugs, to studies that show the overall benefit”.

Edzard Ernst, professor of complementary medicine at the University of Exeter, UK, who has done similar evaluations of these techniques, fears the exercise will be a waste of time. “If it is truly objective, the result is already known, but it will never be accepted by believers.”

Worse, the Swiss may find “false positive” evidence under political pressure. In the UK, he says, such pressure prevented action on a recent parliamentary report finding no evidence for homeopathy. Its use was left to “patient choice”.

When this article was first posted, it incorrectly referred to “the UK’s National Institute of Clinical Excellence”.