MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

During the last decade, Professor Claudia Witt and co-workers from the Charite in Berlin have published more studies of homeopathy than any other research group. Much of their conclusions are over-optimistic and worringly uncritical, in my view. Their latest article is on homeopathy as a treatment of eczema. As it happens, I have recently published a systematic review of this subject; it concluded that “the evidence from controlled clinical trials… fails to show that homeopathy is an efficacious treatment for eczema“. The question therefore arises whether the latest publication of the Berlin team changes my conclusion in any way.

Their new article describes a prospective multi-centre study which included 135 children with mild to moderate atopic eczema. The parents of the kids enrolled in this trial were able to choose either homeopathic or conventional doctors for their children who treated them as they saw fit. The article gives only scant details about the actual treatments administered. The main outcome of the study was a validated symptom score at 36 months. Further endpoints included quality of life, conventional medicine consumption, safety and disease related costs at six, 12 and 36 months.

The results showed no significant differences between the groups at 36 months. However, the children treated conventionally seemed to improve quicker than those in the homeopathy group. The total costs were about twice higher in the homoeopathic compared to the conventional group. The authors conclude as follows: “Taking patient preferences into account, while being unable to rule out residual confounding, in this long-term observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs“.

At least one previous report of this study has been available for some time and had thus been included in my systematic review. It is therefore unlikely that this new analysis might change my conclusion, particularly as the trial by Witt et al has many flaws. Here are just some of the most obvious ones:

Patients were selected according to parents’ preferences.

This means expectations could have played an important role.

It also means that the groups were not comparable in various, potentially important prognostic variables.

Even though much of the article reads as though the homeopaths exclusively employed homeopathic remedies, the truth is that both groups received similar amounts of conventional care and treatments. In other words, the study followed a ‘A+B versus B’ design (here is the sentence that best gives the game away “At 36 months the frequency of daily basic skin care was… comparable in both groups, as was the number of different medications (including corticosteroids and antihistamines)…”). I have previously stated that this type of study-design can never produce a negative result because A+B is always more than B.

Yet, at first glance, this new study seems to prove my thesis wrong: even though the parents chose their preferred options, and even though all patients were treated conventionally, the addition of homeopathy to conventional care failed to produce a better clinical outcome. On the contrary, the homeopathically treated kids had to wait longer for their symptoms to ease. The only significant difference was that the addition of homeopathy to conventional eczema treatments was much more expensive than conventional therapy alone (this finding is less than remarkable: even the most useless additional intervention costs money).

So, is my theory about ‘A+B versusB’ study-designs wrong? I don’t think so. If B equals zero, one would expect exactly the finding Witt et al produced:  A+0=A. In turn, this is not a compliment for the homeopaths of this study: they seem to have been incapable of even generating a placebo-response. And this might indicate that homeopathy was not even usefull as a means to generate a placebo-response. Whatever interpretation one adopts, this study tells us very little of value (as children often grow out of eczema, we cannot even be sure whether the results are not simply a reflection of the natural history of the disease); in my view, it merely demonstrates that weak study designs can only create weak findings which, in this particular case, are next to useless.

The study was sponsored by the Robert Bosch Stiftung, an organisation which claims to be dedicated to excellence in research and which has, in the past, spent millions on researching homeopathy. It seems doubtful that trials of this caliber can live up to any claim of excellence. In any case, the new analysis is certainly no reason to change the conclusion of my systematic review.

To their credit, Witt et al are well aware of the many weaknesses of their study. Perhaps in an attempt to make them appear less glaring, they stress that “the aim of this study was to reflect the real world situation“.Usually I do not accept the argument that pragmatic trials cannot be rigorous – but I think Witt et al do have a point here: the real word tells us that homeopathic remedies are pure placebos!

21 Responses to The real world demonstrates: homeopathic remedies are placebos

  • In the third to last paragraph, in the parentheses, did you mean to say that children often grow out of eczema, and not asthma, as it says now?

  • thanks for spotting this and telling me.
    i have corrected the error

  • What do you think might be the reason for the high level of significance of benefit of verum versus placebo treatment in the long term post cross over phase:
    “Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial”
    It looks too good to be worth believing in.

    • whenever we encounter resuts which look too good to be true – and the ones you cite might well fall into this category – we need independent replications. it would be foolish and perhaps even irresponsible to believe such findings.

  • LOL
    The long term post cross over phase was not blinded.
    This is indicated by the term “open label”.
    I have thought, this would mean something else.
    Children did knew by that point the identity of their medication:
    placebo or their individual homoeopathic prescription.
    Not necessary to say anything further.

  • A bit of information about “Professor” Claudia Witt
    http://www.claudia-witt.org/
    “knowing what works for whom – towards an integrative patient-centered health care”
    Is there another sort of healthcare, other than “patient-centred”, or is that the term alternatives like to use pejoratively to real medicine? This also reveals her intention to use alternative medicine, not conduct research into its medical value.

    http://www.claudia-witt.org/curriculum-vitae/
    “From the outset, Dr. Witt’s career has been dedicated to patient-centered approaches to health care. Her research has made substantial contributions to the evidence on efficacy, effectiveness, cost-effectiveness and safety of complementary and integrative medicine. She is committed to the training of future generations of integrative medicine physicians and researchers; she developed the first postgraduate international summer school on clinical research methods in this field. Over the last 15 years, she has conducted a number of large trials with a total of over 50,000 patients and has published over 120 peer-reviewed publications including papers in leading medical journals.”
    Grandiose claims, and a few porkies. Where is the evidence for the “efficacy….of complementary and integrative medicine” (though it pains me to have that oxymoron), as Witt claims?

    http://www.claudia-witt.org/partnerslinks/
    “Society for Acupuncture Research
    SAR’s mission is to promote, advance and disseminate scientific inquiry into Oriental medicine systems, which include acupuncture, herbal therapy, and other modalities. Since 2013 Dr. Witt serves as a board member. http://www.acupunctureresearch.org
    Quite why she wants to conduct their “scientific inquiry” into Oriental medicine (another oxymoron) when the Cochrane collaboration has evidence aplenty to demonstrate its worthlessness is my question?

    From the few websites about Witt, I get the impression (possible wrongly) that she has a very high degree of self-affection and this colours her view that she is right, evidence notwithstanding. I also intend to send her this URL to see her reaction.

    • Hi Frank,

      “Is there another sort of healthcare, other than “patient-centred”, or is that the term alternatives like to use pejoratively to real medicine?”

      The term “patient-centered” is being used a lot lately in the US to let patients know that it won’t be a 5-10 minute listen to your complaint and write a prescription situation. Lots of allopaths (mainly GPs, but also specialists) have started advertising patient centered practice.

      I know patients appreciate it, as few consider a 5-10 visit real medicine (and rightly so). I don’t think anyone considers it healthcare (also rightly so).

      • @jm,
        I’m in Australia, a relatively civilised place compared with the USA; we have universal healthcare, as well as a minimum wage well above $5 per hour, AND we “ain’t no stinkin’ commos” (as some Americans seem to think such minimum standards are).
        Anyway, the reason I said that is that some strange things come out of the US, not the least of which are strange invented terms. We have “patient centred” too, we call it medicine and healthcare. “write a prescription situation”; we call that medicine too because these drugs have come through rigorous testing (admittedly, with only a couple of failures) that witchcraft escapes.
        As for “allopaths”, we call them doctors because they have studied MEDICINE for a long time and deserve respect. The term “allopath” was invented as an insult and it is. When (more likely than if) you get cancer, are you going to see an “allopath”, or will you trust your life to a homeopath, a Reiki “practitioner”, a naturopath, or even a chiropractor? Yep, the serious question is the one that sorts out what is the real deal, or not.

        “I know patients appreciate it, as few consider a 5-10 visit real medicine (and rightly so). I don’t think anyone considers it healthcare (also rightly so).”
        Part of the reason that witchcraft is liked by so many is that it treats them as “special” (an Australian sports commentator who I find irritating uses the term with an elongation of the “sh” even more annoyingly). It is the personal aspect of the faux consultation which gives people succour, and sucks them into the hoax, hence the placebo effect.

        BUT jm, you do like your witchcraft and I hope it doesn’t kill you before you come to your senses.

        • Hi Frank,

          Here in the uncivilized US many MDs use the term “Allopathic Medicine” in their advertisements and on their signs, forms, etc. Insurance companies use the term as well. I don’t think they mean it as an insult.

          As far as my own views of healthcare, I’m not dogmatic. (It sounds like you are, which is totally your choice – whatever works for you, eh?) Modern medicine is a fantastic option for emergency medicine – broken bones, cancer, diseases that have firmly settled in. It’s a great system for trauma or situations that have gotten out of hand.

          Modern allopathic medicine wouldn’t be my choice for heathcare, though. Modern medicine deals with things once they can be measured. Traditional medical systems focus on dealing with things before they become potent enough to be measured in a quantifiable way. One system for restoring health, another for preserving health. Right tool for the job kind of thing. And skilled practitioners using the tools.

          After discovering this blog a year ago, I would particularly avoid anyone practicing “evidence based medicine” – for anything other than emergency medicine. I had no idea that evidence based medicine required so much faith – faith that researchers understand what they are studying, faith that the practitioners involved are looking at the same diagnostic criteria that you do, treat the same way you do, proper follow up care was recommended (and followed by the subjects), etc etc.

          That’s a lot of required faith – and I’m not into faith based medicine, unless there’s no other choice.

          • jm,
            Please read these before you post again? You may avoid appearing foolish if you refrain from posting illogical nonsense.

            http://rationalwiki.org/wiki/Logical_fallacy
            http://www.nizkor.org/features/fallacies/
            http://www.logicalfallacies.info/
            http://en.wikipedia.org/wiki/List_of_fallacies
            https://yourlogicalfallacyis.com/

            “That’s a lot of required faith – and I’m not into faith based medicine, unless there’s no other choice.”
            Au contraire, all of what you practice is faith-based, (I shouldn’t even need to say this but you leave little choice) because there is NO EVIDENCE for all that witchcraft. That is the basis of faith.
            I am stunned that someone can put so much illogical prose together in such a short post.

          • “Au contraire, all of what you practice is faith-based, (I shouldn’t even need to say this but you leave little choice) because there is NO EVIDENCE for all that witchcraft.”

            Which witchcraft was that again? I’m not sure what you’re referring to.

            (Love the ‘au contraire’, especially in the same sentence with ‘witchcraft’. A lovely blend of continental and superstitious villager with a torch. Well done!)

          • Obviously didn’t read the links. No surprise at the result (and the faux cleverness).
            Yawn.

          • Obviously, you didn’t answer my question: Which witchcraft was that again? I’m not sure what you’re referring to.

          • I repeat because you didn’t absorb the original; “You may avoid appearing foolish if you refrain from posting illogical nonsense.”

          • I repeat, because you still didn’t answer a pretty straightforward question. You said “… all of what you practice is faith-based, (I shouldn’t even need to say this but you leave little choice) because there is NO EVIDENCE for all that witchcraft…”

            I practice massage, scraping, and cupping. None require faith. Cupping and scraping even give you unmistakeable visual data on what’s going on. Subsequent sessions – evidence is palpable, and with scraping & cupping, visual – you can literally see how effective the last treatment was. Really, you can’t get more straightforward than that. No faith, just observation of the evidence.

            There have been some pretty wacky comments on this blog, but I think you’re the first to refer to massage as witchcraft.

          • Frank, you sly dog you. I pulled up the links you posted, trying to figure out what you didn’t understand about my comment on faith. I did notice that your “Au contraire…” comment is made up completely of various fallacies.

            So I started looking at your other comments, on other topics…more and more impressed with each click of the mouse.

            There was a Sumo wrestler 10+ years ago or so, who made his way to the top level of wrestlers by winning each match with a different technique. You are apparently the Asashōryū of logical fallacy – your collection grows more complete by the comment! Well played sir, well played.

  • @jm,
    “I practice massage, scraping, and cupping. None require faith.”
    http://en.wikipedia.org/wiki/Cupping_therapy
    http://skepdic.com/cupping.html
    Since scraping and cupping involve the metaphysical, you clearly are faith-based.

    “Cupping and scraping even give you unmistakeable visual data on what’s going on. Subsequent sessions – evidence is palpable, and with scraping & cupping, visual – you can literally see how effective the last treatment was. Really, you can’t get more straightforward than that. No faith, just observation of the evidence.”
    Observation of what? Cup marks? Other than that, there isn’t a shred of evidence to demonstrate any contribution to better health, apart from as a placebo. Ernst and Singh have made this observation, as have others.

    “There have been some pretty wacky comments on this blog, but I think you’re the first to refer to massage as witchcraft.”
    I didn’t say massage is witchcraft. You are like every other health charlatan; misattribution, selective perception, an overarching confidence in your abilities, and the inability to apply reason and logic.

    • Frank,

      “Since scraping and cupping involve the metaphysical, you clearly are faith-based.” Metaphysical??? Ah, nope. You’ve been led astray there. Neither metaphysical nor faith-based. I’d love to hear how you came to that conclusion, though.

      “Observation of what? Cup marks?” Yup. But you’ve heard all of that before.

      “Ernst and Singh have made this observation, as have others.” Post a link please, I’m curious. I’d love to see how the placebo cup problem was solved. Maybe a laser cup? I hear lasers are in fashion these days.

      “I didn’t say massage is witchcraft. You are like every other health charlatan; misattribution, selective perception, an overarching confidence in your abilities, and the inability to apply reason and logic.” Seriously, Frank? Here’s what you said (I’ll paste it in, but you could just scroll up a bit and read your whole comment):

      “Au contraire, all of what you practice is faith-based, (I shouldn’t even need to say this but you leave little choice) because there is NO EVIDENCE for all that witchcraft.” Um, I practice massage. Or were you not including that when you use the word “all”? Did you actually mean “some”, and somehow mistyped it as “all”? Certainly would be a weird typo.

      I actually thought that was weird enough that I asked you – twice, actually – what you meant. You know, so you could avoid appearing foolish posting illogical nonsense.

      But then right after outright lying (“I didn’t say….etc”), you do the whole name calling with a bonus accusation of misattribution. Are you sure you’re not from the US?

      • jm,
        Heaven help me (even an atheist needs some support from the terminally stupid)!

        “Um, I practice massage.” Where in this thread have you said that you “practice massage”? All you have done is support homeopathy and alluded to your own means of treatment without specifically identifying it, leaving the assumption open that it is homeopathy.
        “Certainly would be a weird typo.”
        No, it wasn’t a weird typo, it was responding to a weirdo.
        “I actually thought that was weird enough that I asked you – twice, actually – what you meant. You know, so you could avoid appearing foolish posting illogical nonsense.”
        This the schoolyard-response, childish nonsense I have come to expect from you.
        “But then right after outright lying (“I didn’t say….etc”), you do the whole name calling with a bonus accusation of misattribution. Are you sure you’re not from the US?”
        You are truly a “True Believer”, for whom no evidence will ever dissuade you from views which science has shown to be unsustainable, so saying anything more to you is pointless.

        • “Where in this thread have you said that you “practice massage”? All you have done is support homeopathy and alluded to your own means of treatment without specifically identifying it, leaving the assumption open that it is homeopathy.”

          Where exactly was I supporting homeopathy? On this thread, I responded to your comment about the term ‘patient centered’, which you brought up regarding Dr Claudia Witt (MD). And I wasn’t supporting the use of the term, either. I think it’s pretty sad that MDs have had to start advertising that they focus on their patients, to set them apart from their competition.

          As far as assumptions go, perhaps you should avoid them. Just a suggestion.

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