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In 1998, the Swiss government began a comprehensive Program for Evaluating Complementary Medicine (PEK : Programm Evaluation Komplementärmedizin = Program for Evaluating Complementary Medicine) to study the role and effectiveness of complementary medicine, which was playing an ever-increasing role in the Swiss medical system. According to the PEK Report, results of the evaluation were inconclusive, and in June 2005, the five complementary therapies under evaluation - anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine (more precisely, traditional Chinese herbal therapy) - were removed from the list of services covered by the compulsory health insurance scheme (KLV).Controversy surrounds the events leading up to the publication of the report.
Summary of the PEK Report The complete text of the 24 April 2005 version of the "Programm Evaluation Komplementärmedizin" Report, (also referred to as PEK, "Program for Evaluating Complementary Medicine" and "Complementary Medicine Evaluation Programme"), is available from the Swiss Parliament websiteComplete text of the official PEK report. (In German, with summaries in German, French, Italian and English.) Accessed June 2007. and also from the Swiss Federal Office of Health (BAG) PEK download webpageVarious PEK related documents, mostly in German, but some also in French, Italian and English, (including the report on the PEK study) can be downloaded from the Swiss Federal Office of Health (BAG) PEK download page. Accessed August 2007..The 96 page report (plus annexes) is written in German, but includes introductions in German (pages i-iv) and French (v-ix), and summaries of the report (and the study results) in German (pages 5-7), French (8-10), Italian (11-13), and English (14-16). The official data is available (in German and French) from the Swiss Federal Office of Public Health (BAG)German Language Wikipedia page for Bundesamt für Gesundheit (BAG). data download pageBAG Health Insurance Statistic Reports download page. (In German and French.) Accessed August 2007..The following sections are extracts from the English summary of the PEK report:
BackgroundFollowing the decision taken by the Swiss 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 five services were only eligible for reimbursement if they were provided by physicians who had the relevant proficiency certificates, issued by the Swiss Medical Association (FMH).The decision on whether these complementary methods would be retained within the basic health insurance scheme was to be based 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.
Design of the PEKA 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.
Results of Part 1 (Evaluation)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 Part 2 (Literature Analysis)The analysis of the literature involved two different projects:
#For each of the five complementary therapies, a comprehensive overall evaluation (evaluation report) was prepared.
#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. Insufficient data were available for meta-analyses of anthroposophical medicine and neural therapy.
Controversy The terms-of-reference for the PEK study stated 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. However, before the study was completed and the final draft report reviewed by the international Review Board, the government announced that it would withdraw support for all complementary approaches to medicineUnipublic Zurich University. Accessed August 2007..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."Peter Fisher, Homeopathy and the Lancet from "Evidence-Based Complementary and Alternative Medicine", 2006 3(1):145-147 Online at OxfordJournals.org. Accessed August 2007.
:"There is a consensus among the review board members that the final PEK process deviated from what would have been expected by conventional standards."Walach H, Linde K, Eichenberger R, Stalder H, Kristensen FB, Kleijnen J. Summary Consensus Statement of the PEK Review Board regarding the PEK process and the PEK products, 27th September 2005. English and German versions available from the BAG PEK download page. Accessed August 2007.
ECH evaluation of PEK reportAccording to the European Committee for Homeopathy's evaluation of the PEK report[http://www.homeopatiaveterinaria.com.br/Report%20on%20PEK%20study.pdf European Committee for Homeopathy's evaluation of the PEK report, Dr Ton Nicolai (ECH President), June 2005.] (In English.) Accessed August 2007., the results were, for the government, surprisingly positive towards complementary medicines. According to the ECH evaluation:
International Review Board's "Consensus Statement"The international review board's "Summary Consensus Statement of the PEK Review Board regarding the PEK process and the PEK products" criticised both the PEK process, and the final report:
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