Homeopathy ends

[Guest guest]

Hi All,

It seems that the final words are in on the effectiveness of homeopathy. It

does

not work, seems to be the bottom line. Is it worth mentioning that homeopathy

was

not significantly but positively associated with improved outcome? Is it

effective

for some and not other treatments?

The below are pdf-available and an editorial, a rebuke of a WHO report that

appears

to favor homeopathy and the not yet medline available abstract for a meta

analysis

of data for the effectiveness of homeopathic versus conventional medicine.

The end of homoeopathy • EDITORIAL

Lancet. 2005 Aug 27-Sep 2;366(9487):690

The Lancet

That homoeopathy fares poorly when compared with allopathy in Aijing Shang and

colleagues' systematic evaluation is unsurprising. Of greater interest is the

fact

that this debate continues, despite 150 years of unfavourable findings. The more

dilute the evidence for homoeopathy becomes, the greater seems its popularity.

For too long, a politically correct laissez-faire attitude has existed towards

homoeopathy, but there are now signs of enlightenment from unlikely sources. The

UK

Parliamentary Select Committee on Science and Technology issued a report about

complementary and alternative medicine in 2000. It recommended “any therapy that

makes specific claims for being able to treat specific conditions should have

evidence of being able to do this above and beyond the placebo effect”. Going

one

step further, the Swiss Government, after a 5-year trial, has now withdrawn

insurance coverage for homoeopathy and four other complementary treatments

because

they did not meet efficacy and cost-effectiveness criteria.

In a Comment, Jan Vandenbroucke gives a philosophical interpretation of Shang's

study. One other philosopher he might have included is Kant, who reminds us that

we

see things not as they are, but as we are. This observation is also true of

health-care consumers, who may see homoeopathy as a holistic alternative to a

disease-focused, technology-driven medical model. It is the attitudes of

patients

and providers that engender alternative-therapy seeking behaviours which create

a

greater threat to conventional care—and patients' welfare—than do spurious

arguments

of putative benefits from absurd dilutions.

Surely the time has passed for selective analyses, biased reports, or further

investment in research to perpetuate the homoeopathy versus allopathy debate.

Now

doctors need to be bold and honest with their patients about homoeopathy's lack

of

benefit, and with themselves about the failings of modern medicine to address

patients' needs for personalised care.

Critics slam draft WHO report on homoeopathy • NEWS

Lancet. 2005 Aug 27-Sep 2;366(9487):705-706

McCarthy

A WHO group that caused controversy with a 2003 report on acupuncture has now

turned

its attention to homoeopathy. But if the allegations of bias levelled at a draft

version of the report are anything to go by, the group has once again put itself

in

the firing line.

Sceptics of alternative medicine are calling for WHO to extensively revise a

draft

report on homoeopathy that they claim is little more than pro-homoeopathy

propaganda.

The report, says Cees Renckens, a gynaecologist and chairman of the Dutch Union

Against Quackery, plays up research that supports homoeopathy while ignoring

studies

that cast doubt on its effectiveness. “I think it is pathetic that WHO is

publishing

this kind of paper”, he told The Lancet. Renckens and others obtained a copy of

the

confidential draft after it was sent out for comments.

WHO officials call the criticism unfair: “It's preliminary and only a draft”,

says

Xiaorui Zhang, who is acting team coordinator for traditional medicine with the

WHO's Department of Essential Drugs and Medicine Policy, which is preparing the

report.

But critics are sceptical. The report's tone and approach are identical to a

controversial 2003 report on acupuncture prepared by the same group, says Willem

Betz, chair of the department for training in family practice at the University

of

Brussels and chair of SKEPP (Studie Kring voor Kritische Evaluatie van

Pseudowetenschap en het Paranormale, the Study Circle for the Critical

Evaluation of

Pseudoscience and the Paranormal).

The acupuncture report stated that acupuncture had been shown to be effective in

controlled clinical trials for more than a score of conditions, including

bacillary

dysentery and leucopenia. The evidence does not support such claims, said Betz.

The

acupuncture report and now the homoeopathy report are evidence that “WHO has

been

infiltrated by missionaries for alternative medicine”, Betz said.

The 40-page draft on homoeopathy, entitled Homoeopathy: review and analysis of

reports on controlled clinical trials, states that the “majority” of

peer-reviewed

scientific papers published over the past 40 years “have demonstrated that

homoeopathy is superior to placebo in placebo-controlled trials and is

equivalent to

conventional medicines in the treatment of illnesses, in both humans and

animals.”

The report describes the findings of a selected group of systematic reviews,

meta-analysis, controlled trials, cost-effectiveness and outcome studies,

observational studies. Almost all of the studies cited support the practice of

homoeopathy.

Edzard Ernst, professor of complementary medicine at the Peninsula Medical

School

(Exeter, UK), said the draft “seems overtly biased, ie, it is based on data that

are

positive while ‘forgetting’ the negative studies and systematic reviews.”

The randomised clinical trials cited, he said, “all happen to be positive; they

are

not the most rigorous ones, not the most recent. This does not inspire the

reader to

think the WHO report was even intended to be objective.”

“I find it terribly worrying”, he added, “because WHO shouldn't be promoting

homoeopathy as it did acupuncture.”

Homoeopathy was developed in the late 1700s by Hahnemann (1755–1843), a

German physician and chemist. Hahnemann argued that it was possible to restore

health by stimulating the body to regain its balance. This could be done, he

said,

by administering substances that provoked the same signs and symptoms as the

disease. He called this the “similia principle” or “like cures like”. The term

homoeopathy is derived from the Greek words homoios (similar) and pathos

(suffering).

In addition to the signs and symptoms of disease, homoeopathic practitioners say

they must also take into account such things as the patient's emotional response

to

their illness, their personality and temperament before deciding on which

homoeopathic regimen to prescribe. Therefore, different patients will receive

different treatments for the same disease, making it difficult to conduct

randomized

controlled trials, homoeopathic practitioners argue.

Hahnemann also believed that it was possible to make homoeopathic preparations,

typically herbal or mineral solutions, more powerful by making the solutions

more

dilute, a principle he called “potentisation”. For potentisation to be effective

it

was necessary that the solution be shaken in a specific manner with each

dilution, a

process he called “succussion.”

Homoeopathic preparations can be so dilute that they do not contain a single

molecule of the original herb. Supporters of homoeopathy contend that such

preparations retain their effectiveness because the water retains a “memory” of

the

“vital essence” of the herb or mineral.

Critics of homoeopathy argue that there is no scientific foundation for such

claims

and no convincing evidence from efficacy from clinical trials. Nevertheless,

homoeopathy is extremely popular and its use on the upswing worldwide.

In recent years, however, a number of reviews and clinical trials have called

the

effectiveness of homoeopathy into question. On its website the National Center

for

Complementary and Alternative Medicine at the US National Institutes of Health

says

that “the results of individual, controlled clinical trials of homoeopathy have

been

contradictory … Systematic reviews have not found homoeopathy to be a

definitively

proven treatment of any medical condition.”

According to its 2002 strategy plan, WHO's traditional medicines programme was

set

up to help countries to develop national policies for the evaluation and

regulation

of traditional and complementary and alternative medical practices, create a

stronger evidence base on the safety and efficacy of TM/CAM (traditional

medicine/complementary and alternative medicine) products and practices, promote

therapeutically sound use of TM/CAM and document traditional medicines and

remedies.

Zhang started out as a “bare foot doctor” in China and went on to train at

Beijing

University of Traditional Medicine. She became Medical Officer in charge of

WHO's

traditional Medicine programme in 1992. In 2002, she became Team Coordinator for

Traditional Medicine in the Department of Essential Drugs and Medicines Policy.

Zhang says given the widespread use of traditional medicine it is important for

WHO

to provide these reports. Many alternative and traditional medicine

practitioners

are not familiar with current scientific research techniques, she said, and that

her

group found the quality of many of acupuncture, homoeopathy, and other TM/CAM

studies to be “very poor”.

“Our purpose is to improve the research approaches and appropriate clinical

studies”, she said.

The reports should be used only as references and should not be taken to be

recommendations, she said. “If you carefully read the introduction (to the

acupuncture report) you will understand what the objectives are and how to read

and

use these documents”, she said.

In that introduction, Zhang wrote that the report was intended to facilitate

research on and the evaluation and application of acupuncture. “Only national

health

authorities can determine the diseases and conditions for which acupuncture

treatment can be recommended”, she writes.

“Perhaps I should move that into the text” of the new homoeopathy report, Zhang

said

in a telephone interview.

But critics say such disclaimers have little effect. Supporters of acupuncture

routinely cite the WHO report as an endorsement of the practice, critics say.

“Any

report WHO puts out will have an impact”, says Ernst, who says in debates

supporters

of acupuncture will counter his evidence by simply citing the claims backed in

the

WHO report. “Who am I against the WHO?”, he asks. “What better name could you

think

of but WHO?”

Ernst says the WHO homoeopathy report should be extensively revised. Among the

changes he would like to see is a methodology section that explains what

criteria

were used to select papers for review and full disclosure of the names—and any

conflicts of interest—of those who drew up the report. “It would be good to see

that

the panel consists of people who are all well informed and that it covers the

entire

spectrum from opponents to proponents of homoeopathy.”

According to a letter that went out with the homoeopathy draft, the document was

prepared based on the discussions at WHO working group meetings held in 2003 and

2004. Zhang declined to reveal the names of the workshop participants, though

she

said their names would be revealed when the final report was released.

Renckens argues that it is wrong that such reports should not be prepared in

secret

behind closed doors: “They should send it to some real experts in pharmacology.

Homoeopathy is a kind of drug so they should have an open appraisal when they

published these kinds of papers and reports”, he said. “Of course, when these

claims

are scrutinised, they will disappear and there would be no report.”

Zhang said that she has received many helpful comments from peer reviewers and

expected that considerable revision would be done. She said she could not say

when

the report might now be released.

Are the clinical effects of homoeopathy placebo effects? Comparative study of

placebo-controlled trials of homoeopathy and allopathy • ARTICLE

Lancet. 2005 Aug 27-Sep 2;366(9487):726-732

Aijing Shang, Karin Huwiler-Müntener, Nartey, Jüni, Stephan Dörig,

AC Sterne, Pewsner and Matthias Egger

Summary

Background Homoeopathy is widely used, but specific effects of homoeopathic

remedies

seem implausible. Bias in the conduct and reporting of trials is a possible

explanation for positive findings of trials of both homoeopathy and conventional

medicine. We analysed trials of homoeopathy and conventional medicine and

estimated

treatment effects in trials least likely to be affected by bias.

Methods Placebo-controlled trials of homoeopathy were identified by a

comprehensive

literature search, which covered 19 electronic databases, reference lists of

relevant papers, and contacts with experts. Trials in conventional medicine

matched

to homoeopathy trials for disorder and type of outcome were randomly selected

from

the Cochrane Controlled Trials Register (issue 1, 2003). Data were extracted in

duplicate and outcomes coded so that odds ratios below 1 indicated benefit.

Trials

described as double-blind, with adequate randomisation, were assumed to be of

higher

methodological quality. Bias effects were examined in funnel plots and

meta-regression models.

Findings 110 homoeopathy trials and 110 matched conventional-medicine trials

were

analysed. The median study size was 65 participants (range ten to 1573). 21

homoeopathy trials (19%) and nine (8%) conventional-medicine trials were of

higher

quality. In both groups, smaller trials and those of lower quality showed more

beneficial treatment effects than larger and higher-quality trials. When the

analysis was restricted to large trials of higher quality, the odds ratio was

0·88

(95% CI 0·65–1·19) for homoeopathy (eight trials) and 0·58 (0·39–0·85) for

conventional medicine (six trials).

Interpretation Biases are present in placebo-controlled trials of both

homoeopathy

and conventional medicine. 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.

Al Pater, PhD; email: old542000@...

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