MD, PhD, FMedSci, FSB, FRCP, FRCPEd

“If ever there was a permanent cure for migraine, homeopathic medicines are the only one that can do this miracle. It may sound like an overstatement and quite quackerish, but it’s true. Long term treatment with homeopathy has an excellent cure for migraine headaches.” Statements like this can be found by the thousands on the internet, not just in relation to migraine but also about osteoarthritis. Both migraine and osteoarthritis are important domains for homeopathy, and most homeopaths would not doubt for a second that they can treat these conditions effectively. This is why it is so important to highlight the few sources which are not misleading consumers into making the wrong therapeutic decisions.

‘Healthcare Improvement Scotland’ (HCIS) have just published advice for patients suffering from migraine and osteoarthritis (the full document with all the evidence can be found here). I think it is worth having a close look and I therefore cite it in full:

Homeopathic remedies are prepared by repeated dilution and vigorous shaking of substances in water. Remedies are prepared from substances that in healthy people cause the signs and symptoms of the condition being treated. The more dilute the remedy is the more potent it becomes so that the most potent remedies are unlikely to contain any of the original substance.

People in Scotland have access to homeopathy through some GPs or a referral to homeopaths in the private sector, regional NHS clinics or the Centre for Integrative Care (CIC) (formerly Glasgow Homeopathic Hospital). Not all NHSScotland health boards provide funding for homeopathy; investment varies widely among those that do, and individual boards have begun to review funding for homeopathy services.

Clinical effectiveness

  • Evidence of clinical effectiveness was reviewed from systematic reviews of four placebo controlled randomised trials of homeopathy for migraine published between 1991 and 1997; and systematic reviews of four active treatment controlled randomised trials of homeopathy for osteoarthritis published between 1983 and 2000. The quality of the evidence was low to moderate.
  • Homeopathy for migraine has not been compared with active treatment in randomised controlled trials (RCTs). Of four RCTs comparing homeopathy with placebo, only one found homeopathy to be superior.
  • Three RCTs in osteoarthritis comparing homeopathy with medicines for pain relief found either no difference between the interventions, or that analgesic treatment had a better effect than homeopathy. A further RCT comparing intra-articular injection of a homeopathic remedy with hyaluronic acid injections showed similar pain reduction in both groups.

Safety

  • Published systematic reviews of homeopathy for migraine and osteoarthritis contain insufficient information to inform conclusions about safety.

Cost effectiveness

  • No evidence on the cost effectiveness of homeopathy for migraine was identified; and the evidence from a single cost-minimisation analysis of one homeopathic preparation for osteoarthritis is not generalisable to the UK.

Context/conclusion

  • Homeopathy for migraine has not been compared with standard care in RCTs and no evidence of cost effectiveness has been identified..
  • There is insufficient evidence to determine whether or not homeopathic treatment for osteoarthritis is clinically effective compared with standard care, and no relevant evidence of cost effectiveness has been identified.
  • The evidence does not support treating migraine or osteoarthritis with homeopathy.

Before the fans of homeopathy start shouting “THIS IS ALL RUBBISH AND DISREGARDS IMPORTANT EVIDENCE!!!”, I should mention that the top experts in homeopathy were asked to contribute their evidence and were unable to find any convincing data that would have changed this negative verdict. And it is important to point out that HCIS is a respected, independent organisation that issues statements based on thorough, unbiased reviews of the evidence.

As I reported a while ago, the Australian ‘NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL’ has assessed the effectiveness of homeopathy. The evaluation looks like the most comprehensive and most independent in the history of homeopathy. Its draft report  concluded that “the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered.”

So, the HCIS is in excellent company and I have no doubt whatsoever that this new statement is correct – but I also have little doubt that homeopaths will dispute it.

 

23 Responses to “The evidence does not support treating migraine or osteoarthritis with homeopathy”

  • “Three RCTs in osteoarthritis comparing homeopathy with medicines for pain relief found either no difference between the interventions, or that analgesic treatment had a better effect than homeopathy.” Is this statement saying that the homeopathic treatment in 3 rct’s was no better than pain relief medicines but was as effective as pain relief medicines?

  • please explain. Surely all rcts should show pain relief medicine was better than homeopathy. There should be no ” no difference between the interventions,” as this implies they worked the same.

    • SOME DO AND SOME DON’T
      what is there to explain? the totality of the evidence fails to be positive. you cannot cherry-pick your evidence.

  • Prof Ernst, how on earth can any rct comparing analgesics with homeopathy ever liken the effectiveness of the 2???? Surely thats just not possible.

  • cherry pick. Good words. You forgot this bit.

    “The systematic reviews showed that the RCT
    comparing oral homeopathy with paracetamol
    found no statistically significant difference in
    the proportion of patients achieving clinically
    significant pain reduction.”.. NO DIFFERENCE TO PARACETAMOL.

    • What about this comment?

      • I don’t know where it is from

        • It’s taken from the study you have linked too and you were a reviewer of the evidence.

          • I see; the whole paragraph reads as follows:
            “The systematic reviews showed that the RCT
            comparing oral homeopathy with paracetamol
            found no statistically significant difference in
            the proportion of patients achieving clinically
            significant pain reduction. Oral NSAID treatment
            resulted in significantly better pain relief than
            homeopathy in the RCT comparing homeopathy
            with fenoprofen whereas this trial found no
            difference between homeopathy and placebo.
            The RCT comparing topical homeopathy with
            a topical NSAID showed pain reduction in both
            groups but no statistically significant difference.”
            I DO NOT CONSIDER THIS ANYWHERE NEAR A PROOF THAT HOMEOPATHY IS EFFECTIVE

  • Oh and what a surprise.
    “Acknowledgements
    Healthcare Improvement Scotland and the Scottish Health Technologies Group (SHTG) invited the
    following individuals and organisations to peer review the draft evidence note:
    • NHS Highland Clinical Advisory Group, Independent topic reviewer
    • Professor Edzard Ernst, Emeritus Professor, University of Exeter, Independent topic reviewer”

    • so?
      do you think that, as a REVIEWER I could have spun the results? I this case you should mention all the others:
      Healthcare Improvement Scotland and the Scottish Health Technologies Group (SHTG) invited the
      following individuals and organisations to peer review the draft evidence note:
      • NHS Highland Clinical Advisory Group, Independent topic reviewer
      • Professor Edzard Ernst, Emeritus Professor, University of Exeter, Independent topic reviewer
      • Professor Gary MacFarlane, Professor of Epidemiology, University of Aberdeen, Topic advisor
      • Dr Robert Mathie, Research Development Adviser, British Homeopathic Association,
      Independent topic reviewer
      • Professor Alex McMahon, Director of Strategic Planning, Performance Reporting & Information,
      NHS Lothian, Independent topic reviewer
      • Rachel Roberts on behalf of the Homeopathy Research Institute, Independent topic reviewer
      Declarations of interest were sought from all peer reviewers. All contributions from peer reviewers
      were considered by the group. However the peer reviewers had no role in authorship or editorial
      control and the views expressed are those of Healthcare Improvement Scotland.
      Healthcare Improvement Scotland development team
      • Heather McIntosh, Lead Author/Health Services Researcher
      • Jenny Harbour, Information Scientist
      • Susan Downie, Medical Writer
      • Marina Tudor, Team Support Administrator
      • Members of the SHTG evidence review committee

      in this case, the homeopaths might have been much more likely to twist the evidence.

  • Prof Ernst. Why the straw man. I asked about the systematic review comparing paracetamol a widely used pain killer with a homeopathic remedy. Not the NSAIDs review.
    “found no statistically significant difference in the proportion of patients achieving clinically
    significant pain reduction.”.. NO DIFFERENCE TO PARACETAMOL.”
    Your views on how a sugar pill is not significantly different to the most widely used pain killer.

    • oh dear!
      the systematic review contains ONE trial of homeopathy vs paracetamol. it suggests that the former is better than the latter. this could have many reasons: coincidence, bias, confounding, fraud. the totality of the evidence comparing homeopathy with conventional drugs, however, fails to be positive. no straw man in sight.

  • “no straw man in sight.” I asked you about one study and you included 2 others. Call that what you might. Did you review the systematic review of this study? Again I’m not talking about homeopathy v conventional drugs, (straw man). I’m talking about this study. I would like to know why you would disregard this review if all protocols were adhered too. What makes this study inconsequential to you? It was after all a systematic review of the evidence.

  • I just realised that you do not understand the terminology – please read up what we mean with SYSTEMATIC REVIEW

  • How on the earth people can be that dull…
    It’s simple : You have X studies of homeopathy in systematic review, some might be positive for homeopathy and the majority of them are negative. Do the stat and you show that homeopathy is efficient as a placebo. Why some stuides might be positive for homeopathy ? Bias, wrong stat, errors, fraud. It’s not because a study is published that it’s true, even more if 10 other studies said the contrary (and it’s the case for every field of science). Otherwise it’s cherry picking, and that’s true that homeopath like cherry picking. So “What makes this study inconsequential to you?” the fact that other studies don’t support that !

    Well it’s why we do systematic review, to avoid misleading positive or negative results or see when it lack results.

  • As dull as a straw man. Iam not and have not been asking about X number of studies. Prof Ernst reviewed the evidence for this piece. I am ASKING ABOUT THE STUDY THAT COMPARES HOMEOPATHY WITH PARACETAMOL. Are you saying that there can be be NO positive studies for paracetamol because its proven to be less effective than NSAIDs? Stop using straw men. Could homeopathy be as effective as paracetamol even though its not as effective as NSAIDS?
    “It’s not because a study is published that it’s true, even more if 10 other studies said the contrary (and it’s the case for every field of science)” DO YOU HAVE 10 STUDIES THAT SHOW PARACETAMOL IS MORE EFFECTIVE THAN HOMEOPATHY? If you do please link.

    I’m not cherry picking, I’m using the evidence provided by HCIS and reviewed by Prof ernst.

  • You are clearly trolling and ignoring half of the message. We don’t care that about “the study that compares homeopathy with paracetamol” because this is not a reproducted data and it could be wrong for the following reason (once again) : Bias, wrong stat, errors, fraud. There is more than hundred studies that show that homeopathy is efficient as a placebo so yes we got studies that state the contrary (even if it’s not paracetamol, who care, we are talking about homeopathy and pain in general). And we got even more studies if we take in account the one who look at the fondamental physics of eventual homeopathic mecanisms explanation (none have shown anything). So please, once more, take in account the stats that show that homeopathy don’t work and “Could homeopathy be as effective as paracetamol even though its not as effective as NSAIDS?” -> NO because one study mean nothing anyway.

    You are cherry picking because you are looking at ONE study in the entire knowledge of the field wich say “no homeopathic effect have been shown in one hundred years”. Is that hard to understand ?

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