Evidence for the effectiveness of homeopathy
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A large study from 1997<ref>[http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)02293-9/abstract Klaus Linde, Nicola Clausius, Gilbert Ramirez, Dieter Melchart, Prof Florian Eitel, Larry V Hedges, Dr Wayne B Jonas MD The Lancet, Volume 350, Issue 9081, Pages 834 - 843, 20 September 1997]</ref> looked at 186 trials, using 119 of them based on inclusion criteria and determined a small apparently positive effect of homeopathy, although nothing conclusive, stating; "The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homoeopathy are completely due to placebo. '''However, we found insufficient evidence from these studies that homoeopathy is clearly efficacious for any single clinical condition.''' Further research on homoeopathy is warranted provided it is rigorous and systematic." (emphasis added). So while the 1997 survey didn't generate strong evidence to say that homeopathy was [[bullshit]], it didn't offer any proof that it had a genuine clinical effect. The study attracted some criticism that the authors "prejudice in favour of homoeopathy is obvious". However, Klaus Linde defended the study and welcomed the criticism, recognising the flaws in corrections of publication bias (a complex topic), the fact that inconsistent methods of action for the [[placebo effect]] could generate further confusing data, and requesting others to look at the data carefully.<ref>[http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)78307-0/fulltext Klaus Linde, Wayne Jonas; Meta-analysis of homoeopathy trials]</ref> | A large study from 1997<ref>[http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)02293-9/abstract Klaus Linde, Nicola Clausius, Gilbert Ramirez, Dieter Melchart, Prof Florian Eitel, Larry V Hedges, Dr Wayne B Jonas MD The Lancet, Volume 350, Issue 9081, Pages 834 - 843, 20 September 1997]</ref> looked at 186 trials, using 119 of them based on inclusion criteria and determined a small apparently positive effect of homeopathy, although nothing conclusive, stating; "The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homoeopathy are completely due to placebo. '''However, we found insufficient evidence from these studies that homoeopathy is clearly efficacious for any single clinical condition.''' Further research on homoeopathy is warranted provided it is rigorous and systematic." (emphasis added). So while the 1997 survey didn't generate strong evidence to say that homeopathy was [[bullshit]], it didn't offer any proof that it had a genuine clinical effect. The study attracted some criticism that the authors "prejudice in favour of homoeopathy is obvious". However, Klaus Linde defended the study and welcomed the criticism, recognising the flaws in corrections of publication bias (a complex topic), the fact that inconsistent methods of action for the [[placebo effect]] could generate further confusing data, and requesting others to look at the data carefully.<ref>[http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)78307-0/fulltext Klaus Linde, Wayne Jonas; Meta-analysis of homoeopathy trials]</ref> | ||
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| + | ===Cochrane Collaboration, 1998=== | ||
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| + | The meta-studies performed by the Cochrane Collaboration are regularly updated. Its study on homeopathic treatment of chronic asthma was first published in 1998 and reassed/updated in 2007. The report looked at various trials of differing quality and "pooled" results; meaning that different remedies were tested, each with a potentially different contribution, and included nearly 600 people. Despite this high risk of bias and false positive results, tt found insufficient evidence for a conclusive answer, and certainly no reliably positive effect. The authors concluded that few studies seemed capable of assessing the "package effect", that whereby the non-clincal aspects of the treatment, such as extended consultations and additional [[woo]]-ing of patients can contribute greatly to the placebo effect.<ref>[http://www2.cochrane.org/reviews/en/ab000353.html Cochrane.org -Homeopathy for chronic asthma]</ref> | ||
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===''The Lancet'', 2005=== | ===''The Lancet'', 2005=== | ||
Revision as of 11:43, 20 July 2010
The evidence for homeopathy, or more specifically the evidence that it is effective beyond a placebo, is far from compelling. While the burden of proof still lies with homeopaths and alternative medicine practicioners to prove its effecitveness, conventional medicine has put it through its paces with a series of trials and meta-studies. The evidence can be split into two categories; the first is that looking at the efficacy of homeopathy, the second is looking into the physical claims such as water memory and quantum woo.
Contents |
Medical evidence
There have been several major investigations into homeopathy. The Lancet, one of the world's premier medical journals, has published a few fairly high quality meta-studies, and the Cochrane Collaboration, practically the place for meta-studies has also released a few studies. In general, these studies come out negative in favour of homeopathy, although keeping with a scientific view of having an open mind some do conclude "insufficient evidence"; while there isn't enough data to conclusively prove that homeopathy is hocum, there isn't any reliable data pointing towards it having a real and tangible effect. Serious high quality research has only been recently available.
The Lancet, 1997
A large study from 1997[1] looked at 186 trials, using 119 of them based on inclusion criteria and determined a small apparently positive effect of homeopathy, although nothing conclusive, stating; "The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homoeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homoeopathy is clearly efficacious for any single clinical condition. Further research on homoeopathy is warranted provided it is rigorous and systematic." (emphasis added). So while the 1997 survey didn't generate strong evidence to say that homeopathy was bullshit, it didn't offer any proof that it had a genuine clinical effect. The study attracted some criticism that the authors "prejudice in favour of homoeopathy is obvious". However, Klaus Linde defended the study and welcomed the criticism, recognising the flaws in corrections of publication bias (a complex topic), the fact that inconsistent methods of action for the placebo effect could generate further confusing data, and requesting others to look at the data carefully.[2]
Cochrane Collaboration, 1998
The meta-studies performed by the Cochrane Collaboration are regularly updated. Its study on homeopathic treatment of chronic asthma was first published in 1998 and reassed/updated in 2007. The report looked at various trials of differing quality and "pooled" results; meaning that different remedies were tested, each with a potentially different contribution, and included nearly 600 people. Despite this high risk of bias and false positive results, tt found insufficient evidence for a conclusive answer, and certainly no reliably positive effect. The authors concluded that few studies seemed capable of assessing the "package effect", that whereby the non-clincal aspects of the treatment, such as extended consultations and additional woo-ing of patients can contribute greatly to the placebo effect.[3]
The Lancet, 2005
The 2005 meta analysis published in The Lancet.[4] This paper examined 110 controlled studies of homeopathy and 110 studies of matched conventional medicine studies. The Lancet study showed that there was no effect beyond that of a placebo for homeopathy. This massive undertaking examined a large amount of evidence and was systematically - i.e., fairly - constructed and carried out. The authors concluded that "when account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects." (emphasis added) The study was criticised by Klaus Linde (author of the 1997 study above) for its high risk of generating a false-positive when restricting itself to larger studies only and pooling the data, as the efficacy of homeopathy may vary across different treatments. He did, however, agree with the conclusion.[5] Shang et. al. responded openly to the criticisms by Linde and others and rectified some of the concerns such as the criticism of using 8 larger trials out of 110 to draw conclusions.[6]
Eur. J. Cancer, 2006
In 2006 European Journal of Cancer showed no effect of homeopathy in a meta-analysis of 6 studies.[7]
J. Alt. Med., 2006
Even sympathetic researchers have problems. Homeopathic practitioners published a study performed in Honduras in the Journal of Alternative Medicine that showed homeopathy to have no effect treating diarrhoea.[8]
Positive trials
Some published positive evidence for homeopathy does exist and these papers are often cited repeatedly by practitioners.[9] However, these studies tend to have many methodological flaws and such flaws make the data less reliable. Ineffective blinding (where people may have been aware that they were receiving administering a placebo rather than treatment) has been known to overestimate the efficacy of a treatment under study by 17%. In addition, ineffective randomisation (where the researchers could choose, consciously or unconsciously, who received the treatment and who received the placebo) can overestimate efficacy by around 30-40%. Taking into account the methods used when analyising data is particularly important if the papers don't mention their methods; i.e., they may have something to hide.[10][11] When taking into account data from flawed experiments and accounting for the flaws, homeopathy still comes out as no more effective than a placebo.[12]
Physical evidence
One of the key goals for modern homepaths is to prove the existence of special properties of water or any solvent that allow them to be clinically active despite having no active ingredient in them - i.e., are just pure solvent. This includes the succussion process that supposedly imparts the memory onto the solvent. These claims aren't entirely beyond medical or scientific testing. As with the medical evidence, this is currently lacking. Some research shows water exists as small, fluxional clusters and dimers in both solution and the gas phase due to its strong propensity for hydrogen bonding. However, these do not explain water memory as they are neither long-lived enough or are affected by a succussion procedure.
At least two studies on homepathic solutions by NMR spectroscopy found no difference. This was true of relaxation times, a property of water protons that can be measured in a magnetic field,[13] Another study looked at the actual spectrum of water produced by NMR. The conclusion was again negative as despite many new NMR signals appearing in the study, most were identified as artefacts, and the rest as known or unidentified impurities and none were found more frequently or specifically in the homeopathic remedies than in the controls.[14]
Footnotes
- ↑ Klaus Linde, Nicola Clausius, Gilbert Ramirez, Dieter Melchart, Prof Florian Eitel, Larry V Hedges, Dr Wayne B Jonas MD The Lancet, Volume 350, Issue 9081, Pages 834 - 843, 20 September 1997
- ↑ Klaus Linde, Wayne Jonas; Meta-analysis of homoeopathy trials
- ↑ Cochrane.org -Homeopathy for chronic asthma
- ↑ Aijing Shang MDa, Karin Huwiler-Müntener MDa, Linda Nartey MDa, Peter Jüni MDa, b, Stephan Döriga, c, Jonathan AC Sterne PhDb, Daniel Pewsner MDa, d and ProfMatthias Egger MD, The Lancet, Volume 366, Issue 9487, 27 August 2005-2 September 2005, Pages 726-732
- ↑ Klaus Linde, Wayne Jonas - Are the clinical effects of homoeopathy placebo effects?
- ↑ Aijing Shang et. al. - Are the clinical effects of homoeopathy placebo effects? — Authors' reply
- ↑ Milazzo S, Russell N, Ernst E Efficacy of homeopathic therapy in cancer treatment. Eur J Cancer. 2006 Feb;42(3):282-9.
- ↑ Jacobs J, Guthrie, B, Montes G, Jacobs L, Colman N, Wilson A, DiGiacomo R. Homeopathic Combination Remedy in the Treatment of Acute Childhood Diarrhea in Honduras. The Journal of Alternative and Complementary Medicine. 2006 Oct;12(8):723-732.
- ↑ British Homeopathic Association - Here they state that 44% of trials were positive while 7% were negative. Although true, this is misleading as it is the quality of research that is important and the research with positive conclusions tend to be very flawed. The major meta-analyses into homeopathy take this into account.
- ↑ Kenneth F. Schulz; Iain Chalmers; Richard J. Hayes; Douglas G. Altman - Empirical Evidence of Bias: Dimensions of Methodological Quality Associated With Estimates of Treatment Effects in Controlled Trials. JAMA, Feb 1995; 273: p.408 - 412.
- ↑ David Moher, Ba' Pham, Alison Jones, Deborah J Cook, Alejandro R Jadad, Michael Moher and others - Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?. The Lancet, Aug 1998; 352, 9128: p.609-613
- ↑ Science Based Medicine - Fun with homeopaths and meta-analyses of homeopathy trials
- ↑ Aabel S, Fossheim S, Rise F. - Nuclear magnetic resonance (NMR) studies of homeopathic solutions
- ↑ Anick DJ, - High sensitivity 1H-NMR spectroscopy of homeopathic remedies made in water