Homeopathy Have Therapeutic Effect?
January 1998; Volume 1: 11-12
Source: inde K, et al. Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 997;350:834-843.
Homeopathy seems scientifically implausible, but it has widespread use. Linde et al aimed to assess whether the clinical effect reported in randomized controlled trials of homoeopathic remedies is equivalent to that reported for placebo.
The authors used studies from computerized bibliographies and contacts with researchers, institutions, manufacturers, individual collectors, homoeopathic conference proceedings, and books. Double-blind and/or randomized, placebo-controlled trials of clinical conditions were considered. Of 186 trials identified, 119 met the inclusion criteria. Eighty-nine had adequate data for meta-analysis, and two sets of trials were used to assess reproducibility. Two reviewers assessed study quality with two scales and extracted data on clinical condition, homoeopathy type, dilution, remedy, population, and outcomes.
The combined odds ratio for the 89 studies entered into the main meta-analysis was 2.45 (95% CI; 2.05, 2.93) in favor of homoeopathy. The odds ratio for the 26 good-quality studies was 1.66 (1.33, 2.08), and that corrected for publication bias was 1.78 (1.03, 3.10). Four studies on the effects of a single remedy on seasonal allergies had a pooled odds ratio for ocular symptoms at four weeks of 2.03 (1.51, 2.74). Five studies on post-operative ileus had a pooled mean effect size difference of 20.22 standard deviations (95% CI; 20.36, 20.09) for flatus and 20.28 SDs (20.33, 20.03) for stool (both P < 0.05).
The results of this meta-analysis are not compatible with the hypothesis that the clinical effects of homoeopathy are completely due to placebo. Linde et al concluded that there is insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition.
COMMENT
A method of treating disease by drugs given in very small doses which, if given in large doses, produce symptoms similar to those of the disease, homeopathy espouses a "law of similars." Its practitioners do detailed examinations and create "infinite dilutions" of patho-gens to treat their patients.
Placebo is the first word that most physicians think of when they think of homeopathy. Its logic seems to fly in the face of established biomedical models of disease and physical and chemical bases of pharmacology.
Yet, this state-of-the-art meta-analysis, controlled for quality, multiple biases, and methodologies, suggests that placebo is not all there is to it.
What are the potential problems with this meta-analysis? Negative trials might not have been published and therefore could not be reviewed. Lumping together all randomized trials for all conditions in all literatures may hide trends in one disease or in a form of homeopathy. Only the best quality studies overall showed adequate evidence of concealment of treatment allocation and handling of dropouts. Meta-analysis itself has problems as a methodology; its results may diverge from the best randomized study. But, otherwise, it is hard to argue with this detailed, careful report.
Recommendation
Evidence-based medicine here provides evidence that homeopathy cannot be all placebo. If certain dilutions or types of homeopathy can benefit patients without harm, then good-quality trials should be on the way, and practitioners should be on the lookout for them. Certain infectious and immunologic diseases seem especially amenable to careful study.
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