MD, PhD, FMedSci, FSB, FRCP, FRCPEd

 

This new systematic review by proponents of homeopathy (and supported by a grant from the Manchester Homeopathic Clinic) tested the null hypothesis that “the main outcome of treatment using a non-individualised (standardised) homeopathic medicine is indistinguishable from that of placebo“. An additional aim was to quantify any condition-specific effects of non-individualised homeopathic treatment. In reporting this paper, I will stay very close to the published text hoping that this avoids both misunderstandings and accusations of bias on my side:

Literature search strategy, data extraction and statistical analysis followed the methods described in a pre-published protocol. A trial comprised ‘reliable evidence’ if its risk of bias was low or it was unclear in one specified domain of assessment. ‘Effect size’ was reported as standardised mean difference (SMD), with arithmetic transformation for dichotomous data carried out as required; a negative SMD indicated an effect favouring homeopathy.

The authors excluded the following types of trials: studies of crossover design; of radionically prepared homeopathic medicines; of homeopathic prophylaxis; of homeopathy combined with other (complementary or conventional) intervention; for other specified reasons. The final explicit exclusion criterion was that there was obviously no blinding of participants and practitioners to the assigned intervention.

Forty-eight different clinical conditions were represented in 75 eligible RCTs; 49 were classed as ‘high risk of bias’ and 23 as ‘uncertain risk of bias’; the remaining three trials displayed sufficiently low risk of bias to be designated reliable evidence. Fifty-four trials had extractable data: pooled SMD was -0.33 (95% confidence interval (CI) -0.44, -0.21), which was attenuated to -0.16 (95% CI -0.31, -0.02) after adjustment for publication bias. The three trials with reliable evidence yielded a non-significant pooled SMD: -0.18 (95% CI -0.46, 0.09). There was no single clinical condition for which meta-analysis produced reliable evidence.

A meta-regression was performed to test specifically for within-group differences for each sub-group. The results showed that there were no significant differences between studies that were and were not:

  • included in previous meta-analyses (p = 0.447);
  • pilot studies (p = 0.316);
  • greater than the median sample (p = 0.298);
  • potency ≥ 12C (p = 0.221);
  • imputed for meta-analysis (p = 0.384);
  • free from vested interest (p = 0.391);
  • acute/chronic (p = 0.796);
  • different types of homeopathy (p = 0.217).

After removal of ‘C’-rated trials, the pooled SMD still favoured homeopathy for all sub-groups, but was statistically non-significant for 10 of the 18 (included in previous meta-analysis; pilot study; sample size > median; potency ≥12C; data imputed; free of vested interest; not free of vested interest; combination medicine; single medicine; chronic condition). There remained no significant differences between sub-groups—with the exception of the analysis for sample size > median (p = 0.028).

Meta-analyses were possible for eight clinical conditions, each analysis comprising two to 5 trials. A statistically significant pooled SMD, favouring homeopathy, was observed for influenza (N = 2), irritable bowel syndrome (N = 2), and seasonal allergic rhinitis (N = 5). Each of the other five clinical conditions (allergic asthma, arsenic toxicity, infertility due to amenorrhoea, muscle soreness, post-operative pain) showed non-significant findings. Removal of ‘C’-rated trials negated the statistically significant effect for seasonal allergic rhinitis and left the non-significant effect for post-operative pain unchanged; no higher-rated trials were available for additional analysis of arsenic toxicity, infertility due to amenorrhoea or irritable bowel syndrome. There were no ‘C’-rated trials to remove for allergic asthma, influenza, or muscle soreness. Thus, influenza was the only clinical condition for which higher-rated trials indicated a statistically significant effect; neither of its contributing trials, however, comprised reliable evidence.

The authors concluded that the quality of the body of evidence is low. A meta-analysis of all extractable data leads to rejection of our null hypothesis, but analysis of a small sub-group of reliable evidence does not support that rejection. Reliable evidence is lacking in condition-specific meta-analyses, precluding relevant conclusions. Better designed and more rigorous RCTs are needed in order to develop an evidence base that can decisively provide reliable effect estimates of non-individualised homeopathic treatment.

I am sure that this paper will lead to lively discussions in the comments section of this blog. I will therefore restrict my comments to a bare minimum.

In my view, this new meta-analysis essentially yield a negative result and confirms most previous, similar reviews.

  • It confirms Linde’s conclusion that “insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition”.
  • It confirms Linde’s conclusion that “there was clear evidence that studies with better methodological quality tended to yield less positive results”.
  • It confirms Kleinjen’s conclusion that “most trials are of low methodological quality”.
  • It also confirms the results of the meta-analysis by Shang et al (much-maligned by homeopaths) than “finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.”
  • Finally, it confirms the conclusion of the analysis of the Australian National Health and Medical Research Council: “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.”

Another not entirely unimportant point that often gets missed in these discussions is this: even if we believe (which I do not) the most optimistic interpretation of these (and similar data) by homeopaths, we ought to point out that there is no evidence whatsoever that homeopathy cures anything. At the very best it provides marginal symptomatic relief. Yet, the claim of homeopaths that we hear constantly is that homeopathy is a causal and curative therapy.

The first author of the new meta-analysis is an employee of the Homeopathy Research Institute. We might therefore forgive him that he he repeatedly insists on dwelling on largely irrelevant (i. e. based on unreliable primary studies) findings. It seems obvious that firm conclusions can only be based on reliable data. I therefore disregard those analyses and conclusions that include such studies.

In the discussion, the authors of the new meta-analysis confirm my interpretation this by stating that they “reject the null hypothesis (non-individualised homeopathy is indistinguishable from placebo) on the basis of pooling all studies, but fail to reject the null hypothesis on the basis of the reliable evidence only.” And, in the long version of their conclusions, we find this remarkable statement: “Our meta-analysis of the current reliable evidence base therefore fails to reject the null hypothesis that the outcome of treatment using a non-individualised homeopathic medicine is not distinguishable from that using placebo.” A most torturous way of stating the obvious: the more reliable data show no difference between homeopathy and placebo.

57 Responses to New meta-analysis confirms that the clinical effects of homeopathic remedies do not differ from placebos

  • It is difficult to see how anyone can dispute the above analysis. All I can say is: will science now turn its attention to individualized homeopathy?

    This is not a good study:
    Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial
    (A White1, P Slade2, C Hunt3, A Hart4, E Ernst1); http://thorax.bmj.com/content/58/4/317.short

    This is a good study, but has mixed results:
    A systematic review of systematic reviews of homeopathy, E. Ernst
    http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2125.2002.01699.x/full

    • what are your qualifications for making categorical statements about clinical research?
      do you have any relevant experience, training or skills?
      can you show us some of your publications?
      OR ARE YOU TALKING OUT OF YOUR ARSE?

      • If you are unable to assess whether comments made are valid or invalid to the analysis without referencing your questions then it suggests that you hold high value on the answers to your questions rather than the comments themselves.

        The answers to your questions are irrelevant; focus your attack on the topic/comments and not the person.

        By the way, have you considered that your language can be somewhat vulgar? You are obviously a very clever person but there is more to a human being than being clever.

    • You are wrong, this is a good study:
      Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial
      (A White1, P Slade2, C Hunt3, A Hart4, E Ernst1); http://thorax.bmj.com/content/58/4/317.short

    • @Greg:

      This is not a good study:

      What’s wrong with it?

      • he does not like the resuts

        • Two homeopaths and you did a study on a cohort of asthma patients who retained use of their medications.

          First questions: how where the two homeopaths selected?, what where there qualifications? and what oversight did UK homeopathic profession have on this study? Who verified their case analysis and remedy selections?

          I will return to this after the Easter weekend.

          Edzard: he does not like the results.

          It is sad Professor Edzard Ernst, really.

          • I don’t even know what study you are talking about, neither do I know why I should answer you inquisition.

          • I notice that you fail to clarify why this study mentioned earlier in not good. If there is more than “I just don’t like the results” then you should be able to elaborate. If not then it really is “I just don’t like the results”.

          • @Greg?

            First questions: how where the two homeopaths selected?, what where there qualifications? and what oversight did UK homeopathic profession have on this study? Who verified their case analysis and remedy selections?

            No true Scotsman, eh?

          • Incidentally, Greg, have you tried reading the study?

  • The following sentence in the ‘Discussion’ section caught my attention:

    With only three studies that can be classified as reliable evidence, it is difficult to separate an effect of homeopathy from the effect of poor quality.

    Indeed, and in all the trials with low risk of bias (as well as a large majority in the “uncertain risk” and “high risk” categories), it is damn nigh impossible to separate an effect of homeopathy from statistical ‘noise’.

    They seem to be going to extraordinary lengths to try to demonstrate the existence of a minuscule effect.

  • My summary of the SR.

    There’s a lot of evidence, most of which is complete rubbish. The little good evidence which exists shows homeopathy is no more effective than a sugar pill.

    Credit to the researchers for a well conducted SR.

    Their findings are completely consistent with others.

    IMO homeopathic remedies should not be allowed for sale without a clear indication to users that they are purchasing a placebo.

  • I’ve only just started to go through the paper but I see that Mathie uses the same trick as he did in his individualised homeopathy paper: that of using the WHO’s International Classification of Functioning, Disability and Health (ICF) rather than the primary outcome measures declared by the trial authors. The ICF is ‘the WHO framework for measuring health and disability at both individual and population levels’. The system provides a method of classification, but does not provide a means of ranking health conditions and it does not appear to have been validated for such use. They do not classify it as a method of ranking importance of outcomes in clinical trials.

    I can’t see anything in Mathie to say how they applied the ICF and which outcome measures in which trials they changed as a result – can anyone else? Come to think of it, I don’t think he gave the same information in his individualised paper. This, to me, seems like a very serious omission.

  • On a separate matter: I read one of Professor Edzard Ernst’s comments in an earlier blog where he stated that President Donald Trump is a thug.

    Of course, Democrats are sad that Mrs Clinton lost the election but going as far as naming the President of the United States, who is leader of the free World, a thug really speaks for itself.

    Professor Edzard Ernst displays an arrogance that is breathtaking.

    • will you repeat that, once he has started WW3?

      • Once he started WW3? You can’t be serious Professor Ernst; these conflicts have been building over decades. So, if you work it out: all matters that have developed before he become President are coming to a head.

        Now, you are joking, right?

    • Thug, fool, narcissist, psychopath, crook, traitor.
      These were all descriptions that were regularly, and quite reasonably, applied to the man known as Donald Trump before he became President.

      The fact that the USA chose to elect Donald Trump President, and thereby bring disrepute on that office, has nothing to do with whether these were accurate descriptions of Trump or whether they should continue to apply to him.

      Becoming President does not make him invulnerable to continued criticism based on his past behaviour (that’s how dictatorships work).

      You, Sir, are the one whose arrogance is breathtaking, along with your dimwitted support for a thug.

      • Sixty two million Americans voted for him to become President.

        • not to mention the Russian hackers

          • Oh my God, you are into conspiracy theory Professor Ernst! This is the United States of America that we are discussing and not some tinpot dictatorship.

            Professor Ernst, do yourself a favor and stick to your area of expertise, which in all fairness to you: it is good.

          • It seems like you have been following developments on this matter closely.

          • The rest of the world (much much bigger than US) tends to follow closely any developments that may endanger peace in our world. We have the experience and we detect in the present head of state, a worrying degree of grandiose delusions and narcissistic traits which remind us of a terrible past. Yes, we follow quite closely what is happening on the other side of the big pond.

          • There is nothing new about Russia’s hacking elections all over the world. Had Bill’s enabler been elcted POTUS, the media would not have covered the issue nearly as enthusiastically as it has since Trump’s inauguration; the story would have been buried in similar fashion to the Susan Rice controversy. Russia’s alleged use of computer hacking to interfere with the U.S. presidential election fits a pattern of similar incidents across Europe for at least a decade.

            Cyberattacks in Ukraine, Bulgaria, Estonia, Germany, France and Austria that investigators attributed to suspected Russian hackers appeared aimed at influencing election results, sowing discord and undermining faith in public institutions that included government agencies, the media and elected officials.

            “They’ve been very good at using the West’s weaknesses against itself, the open Internet to hack, the free media to sow discord, and to cause people to question the underpinnings of the systems under which they live,” said Hannah Thoburn, a research fellow at the Hudson Institute, a Washington think tank.

            U.S. National Intelligence Director James Clapper told a Senate committee Thursday that Russian intelligence hackers, masquerading as third parties, have conducted attacks abroad that targeted critical infrastructure networks. “Russia also has used cyber tactics and techniques to seek to influence public opinion across Europe and Eurasia,” Clapper said.

            A declassified intelligence report on the Russian hacking released Friday accused Russian President Vladimir Putin of ordering the effort to help elect Trump. It warned that Russia would use lessons learned from the effort to disrupt elections of U.S. allies.

        • And huge numbers of people use homeopathy. Obviously there cannot be any possible argument against something that has widespread public support.

          What’s that I hear? Argumentum ad populum? It’s a fallacy?! Gosh darn! Who’d have ever guessed?

      • I take it that JonB was a fan both of the community organizer and of Bill’s enabler. Despite the leftist media and its constant thrum of anti-Trump detritus, Trump has already accomplished much in his nascent presidency.

        He’s canceled TPP (The Trans-Pacific Partnership) that would have caused more jobs to go overseas.

        He met with Tech giants like Mark Zuckerberg of Facebook and Bill Gates, Jeff Bezos along with many others all at once to discuss the future with them. Obama never did that.

        He’s starting to consider designs for the wall along our border in March and has appropriated funds for it.

        He has attempted to initiate a temporary travel ban on citizens from countries in which extreme vetting is not possible only to be delayed by liberal judges whose baseless decisions will likely be overturned by the SCOTUS.

        He’s appropriated funds and signed into law funds to build up our military and take care of our vets. Our military is now at pre ww11 levels thanks to the cuts made by Obama and Obama fired 1000 officers.

        He’s started funds for the Keystone and Dakota pipeline and told them to buy only American steel for the pipeline.

        He’s putting together a health care law that will be fair to everyone including buying across state lines and health care savings accounts among other factors that will be cost effective for everyone. Remember Obama said if you like your plan and doctor you can keep them? Five million people lost their plan and doctor under Obamacare and plans and doctors are dropping out of it.

        He plans on lowering taxes by seven points for the middle class and lowering business taxes down to 15%. Hillary planned to raise taxes on small business up to 43% and raise the inheritance tax to 61%.

        The stock market has been rallying like never before for over 20 days now because Trump got in office.

        He’s convinced companies like Ford, Chrysler and Carrier Air Conditioners to manufacture and build plants over here.

        He also enforce the Syrian Red Line: Obama didn’t have the guts to do it.

        • and Hitler built the Autobahns, several high security prisons, made the trains go in time, boosted the industry, united Germany with Austria, had excellent relations with nations like Italy and Japan… do you need more?

          • America squelched Hitler and his acolytes who had conspired to kill millions of innocent Jews. As you apparently are unaware, America has The Constitution which does not allot complete authority to a president. The Legislature and Judiciary have already obstructed some of Trump’s plans; the separation of powers is working just fine in the USA. Claims that Trump is a fascist or the second coming of Hitler reek of ignorance and sensationalism. You need more?

          • thanks for the history lesson!
            now here is mine: Germany too ad a constitution.

          • Logos-Bios, just for your information, America kept *out of the war* until it was attacked by the Japanese Empire and probably would have continued to do so with regard to the European theater had Hitler not declared war on the USA. Remember, it was Germany who declared war on the US, not the other way round. Roosevelt had even extreme difficulties to ensure the lend-lease program. The real heroes here are the Brits, got it ?

          • @Mohr

            The Brits were definitely heroes; I didn’t state otherwise. Your recounting of WW2 history didn’t obviate the facts I stated. Why did you bother to comment at all? Just wonderin’.

          • Separation of powers was not well respected by Germany when Herr Hitler came to power, was it? It is generally respected, and adhered to, in the USA. Strain your credulity all you want, you will be unable to mount a convincing argument that America is on its way to a dictatorship at all similar to Hitler’s.

    • This is off topic Greg but your support for Trump validates your lack of judgement, character,ethics or morality. Do you not understand what an arrogant narcissist and con artist he is. I am sure you do.

  • Dr. Ernst, admiro y sigo su investigación! Gracias!

    Dr. Ernst I admired and I follow your research! Thank you!

  • Mojo: have you tried reading the study.

    Your link is not the study: that would be a volume containing the case histories and rationales for the remedy selections for each patient. That should be read, can you provide the link please? Thank you.

    • I don’t understand why you are asking for the link? You should have a link and you should have read it because you claimed that its not a good study. Or did you say it without reading the study? Then Edzard was right. You said it only because you just don’t like the results.

    • @Greg:

      No, it is not the study; it is the link you yourself provided above. But if you click on the link that says, “View Full Text” you can read it.

      Perhaps you should have done that before deciding whether or not it was a good study.

      • Thank you Mojo; the full text that you refer to is the Report on the study and not the study itself which would be a volume of work containing the case notes and justifications for the individual prescriptions. This would provide an insight into the homeopathic methodology used by the prescribers and inform the analysis further.

        The one of the questions I asked Professor Ernst: were the prescriptions of the two homeopaths assessed by a professional panel of homeopaths? Ernst refers to this question as part of my ‘inquisition’.

        He made fun of Mr D.Ullman’s court testimony but I would love to see Edzard testifying in a case; that would be so much fun.

  • In examining the contract, my attorney was compelled to say escape artiste James “the Amazing” Randi’s offer to pay $1 million for proof of homeopathy was offered to me unilaterally, that it was similar to a greased pole climbing contest, wherein the offer to pay a large sum of money to anyone who could climb the pole could be snatched back as soon as a professional arrived with spikes.
    This is what happened when I presented to Randi physico-chemical testing of homeopathic medicine. The offer was retracted by Randi.
    I am much aggrieved to say this was not the only time I have dealt with dishonesty in objectively proving homeopathy.

    In an intrinsically flawed review of an an unnamed meta-analysis of homeopathy, Prof. Edzard Ernst presents his long-standing theory once again asserting that homeopathic remedies are placebos . . whatever that means . . because the study said
    “Our meta-analysis of the current reliable evidence base therefore fails to reject the null hypothesis that the outcome of treatment using a non-individualised homeopathic medicine is not distinguishable from that using placebo.”
    Well!
    Like most arguments taken to be against homeopathy proving that the pharmaceuticals used in it are inert, the statement, coming from Ernst, flings a boomerang:
    The study was for NON-individualized use of homeopathic medicine?
    What was the name of this study? Who were the authors? Why is Prof. Ernst not imparting these important details to us?
    Homeopathy has to be individualized to ensure best outcomes for clinical conditions.
    And what’s wrong with “placebo” if the patient is happy?
    But for value’s sake, once again let’s examine Prof. Ernst’s placebo assertion, or better yet, let’s tear it apart:
    Ernst writes ‘It confirms Linde’s conclusion that “insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition”.
    Of course! What would you expect? All the studies analyzed by Linde were not testing for the same single clinical condition! The question Linde was raising was the question as to whether or not homeopathic medicines in general are placebos.
    In his reviews homeopathic medicine Ernst is conflating questions. What he is not quoting from Linde is the previous sentence to their conclusion: “The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo”.
    NOT COMPATIBLE?
    Homeopathy’s premier reviewer is quoting from a study that concludes homeopathic medicines are not placebos?
    But he continues! Prof. Ernst writes ‘it confirms Kleinjen’s conclusion that “most trials are of low methodological quality”’ as if this is a meaningful conclusion. What he does not mention is that Kleijnen, a 1992 systematic review of homeopathic clinical trials published in the BMJ, made a much more skeptic shattering conclusion when they also stated that “we would accept that homoeopathy can be efficacious, if its mechanism of action were more plausible”.
    What!? The British Medical Journal stated that HOMOEOPATHY COULD BE TAKEN TO BE EFFICACIOUS IF ITS MECHANISM OF ACTION WERE MORE PLAUSIBLE?
    What’s this you say? In a study quoted by Prof. Edzard Ernst, Dean of Homeopathy Bashing, the medical professionals at this esteemed medical Journal have asserted that they can accept the efficacy of homeopathy is someone would just explain to them how it works?
    No problem! This I have done, I have explained the mechanism of action for homeopathy in conventional terms. Is not all that is left for me to do now is to collect my Nobel Prize and spend the rest my life peacefully in my ancestral home overlooking the Pacific Ocean, if not be awarded a chair at Exeter?
    No?
    Nevertheless, why is not the focus here on elucidating the mechanism of action for homeopathy, when it is obvious that it is, as I have so generously pointed out, perpetual hydrolytic ionization?
    The unnamed study not reviewed here by Ernst, by the way, is “Randomised, double-blind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis” by Robert Mathie et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366148/
    The principle study not reviewed here by Ernst, by the way, is the preceding study to the unidentified study he did review, namely Mathie’s “Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326322/. It conservatively concluded “Medicines prescribed in individualised homeopathy may have small, specific treatment effects.” In other words, as found with all other preceding meta-analyses, homeopathic medicines are not placebos.
    At this point I think there’s something that should be asserted, if not reiterated, about these random controlled trials of homeopathy, and that is that they are mainly done for the unwashed, the skeptic, the unbeliever. They are not the best proof for homeopathy. In lieu of chemical testing, they are essentially addressing whether or not homeopathic medicines are inert, if they have a distinct chemistry to themselves. Clinical RCTs have little or no use to the practicing homeopath.
    The best value and proof homeopathy is to be found in the semiological registers of the materia medica, the US Federal Drug Administration’s recommended reference work, the core literature of homeopathy containing the record of treatment and cure using ionized pharmaceuticals. In the primary 1600 page reference work recommended by the FDA (Clarke) the word “cured” is used 1,352 times, establishing a comprehensively detailed curative record for the use of homeopathic medicine.
    There is no comparison that I have seen in allopathic medicine.

    • ” there’s something that should be asserted, if not reiterated, about these random controlled trials of homeopathy, and that is that they are mainly done for the unwashed, the skeptic, the unbeliever”
      you are demonstrably wrong – just check the authors’ affiliations.

      • I had a quick look and found only one or two studies by investigators who one might classify as ‘unbelievers’ in homeopathy, a few where I don’t know the authors and therefore cannot be sure, and many [the vast majority] who are clearly believers in homeopathy – or would you not agree that these individuals are famously pro-homeopathy?:
        Belon [2 RCTs]
        Frass [1 RCT]
        Gerhard [3 RCTs]
        Jacobs [2 RCTs]
        Lewith [1RCT]
        Oberbaum [2 RCTs]
        Reilly [3 RCTs]
        Wiesenauer [5 RCTs]
        and roughly the same applies to the Mathie meta-analysis of INDIVIDUALISED homeopathy (https://www.ncbi.nlm.nih.gov/pubmed/25480654) – some of the famously pro-homeopathy investigators:
        Bell
        Brien
        Fisher
        Frass
        Jacobs [6 RCTs]
        Rastogi [2 RCTs]
        Thompson
        Wallach
        Weatherley-Jones

    • Nice to see you again John.

      Quote: “In an intrinsically flawed review of an an unnamed meta-analysis of homeopathy,” We have already established that you do not know how to evaluate clinical studies, therefore you can not decide wether this review is flawed or not.

      However, let’s answer to a few points:

      Quote: “Homeopathy has to be individualized to ensure best outcomes for clinical conditions.”

      That does not render RCTs not fit to test homeopathy – which consistently fails since 1835.

      Quote: “What!? The British Medical Journal stated that HOMOEOPATHY COULD BE TAKEN TO BE EFFICACIOUS IF ITS MECHANISM OF ACTION WERE MORE PLAUSIBLE?”

      Quote: “It conservatively concluded “Medicines prescribed in individualised homeopathy may have small, specific treatment effects.” In other words, as found with all other preceding meta-analyses, homeopathic medicines are not placebos.” Small, specific treatment effects are normally a strong hint for a placebo.

      As I said, John. You have NO experience and NO knowledge of how to assess clinical studies.

      Oh John. That is exactly the problem. Ever heard of prior probability? With a prior probability of zreo (due to the violation of several scientific theories) homeopathy would have to present *extremely* well designed studies and experiments. You know the Sagan quote: Extraordinary claims require extraordinary evidence ?

    • “what’s wrong with “placebo” if the patient is happy?”

      That’s the same argument used by every would-be despot. Gain power by fooling more gullible people into thinking you’re doing them good, regardless of the truth of what you’re doing. The approach is used inevitably by religious leaders, but also by confidence tricksters in every sphere of life, and by cynical politicians who are greedy for control over others.

      With pseudo-medicine you have the extra difficulty that you can’t predict which individual will respond positively to placebo treatments. Using a blunderbuss, unvalidated treatment on the basis that you can point to a proportion of “happy” patients (and ignoring the majority who don’t show any effects) is fundamentally fraudulent.

      • Frank

        “With pseudo-medicine you have the extra difficulty that you can’t predict which individual will respond positively to placebo treatments.”

        That’s an interesting comment. Can you easily predict which individual will respond positively to non-pseudo-medicine?

    • John, you are correct. Homeopathy is an individualised medicine; no two cases are alike.

      A comment I posted on Professor Ernst’s asthma study is missing: I stated that one cannot infer from the study that homeopathy is not efficacious in the treatment of asthma.

      The rationale of the study is:
      In a randomised, double blind, placebo controlled trial the effects of individualised homeopathic remedies were compared with placebo medication in 96 children with mild to moderate asthma as an adjunct to conventional treatment.

      What that says is that if people are already on effective medication for their asthma then individualised homeopathic medicines do not add benefit to improvement of the asthma symptoms. I agree that they would not do so and would like to add that long term treatment of an individual with asthma could extend over several years.

      The other information on this study that is not detailed is what other conditions did each of the individuals with asthma suffer from? The individual differences impact on the overall outcomes.

      I will state this again: homeopathy is an individualised treatment whose outcomes vary according to each individual.

  • Who are the megalomaniac narcissists?

    Kim Yong-un
    Vladimir Putin
    Ali Khamanei
    Bashar al Assad
    Donald J. Trump

    Who are you going to ask to protect you?

    • because we are surrounded by dictators, we need a deranged liar for protection?
      the ‘like cures like’ principle in politics???

    • You can add Hitler and others like him to your list Greg, but hopefully most of us will still reject them for protection and hope those of you who have been conned by the “Deceiver in Chief” will change as more evidence of his inability to be truthful or compassionate is understood.

      • It appears that Cox is concerned that Trump might be able to abolish the Ocare entitlement, thereby costing him Medicaid dollars. Perhaps Cox has been deceived by European collectivists and their notions about socialized healthcare; as long as he gets paid, who cares that the ultimate Ocare endpoint(single-payer) would give the US government significantly more control over its citizens? If redistribution of wealth is his desire, Medicare-for-all would be a quick way to accomplish it.

        Why does Cox think Trump is not compassionate? Perhaps it is because he advocates for extreme vetting and a temporary ban of people from countries whose record-keeping is so pathetic that their citizens’ backgrounds cannot be fully explored. Perhaps Cox is simply typing absurdities resultant to his post-election, depressed emotional state. Who really knows? Perhaps Cox might enlighten this blog to his justifications for such an allegation?

  • Dear Edzard,

    You’ve made me smile. You are well pleased with my group’s new meta-analysis on non-individualised homeopathic treatment – which uses the same methods as my 2014 paper on individualised homeopathic treatment that you so disliked and whose cautiously positive findings you denounced as biased. As you’ve previously said yourself, it is important to accept reliable evidence, whether we like that evidence or not. Both my papers reflect state-of-the-art meta-analysis: they have equally high quality, and therefore possess equal weight and truth. The very small volume of reliable RCT evidence – for either type of homeopathic intervention – does not enable decisive conclusions. And there is more to it than just the internal validity of an RCT..

    You’ve also saddened me. You highlight what you regard as the new study’s conclusion: ‘The more reliable data show no difference between homeopathy and placebo’; but, disappointingly, you’ve conflated non-individualised and individualised homeopathy. The distinction between the two types of intervention is a key facet of my group’s systematic review programme. The new paper examines RCTs in which a single pre-selected medicine was used in every patient to treat the typical symptoms of a disease, whereas the 2014 paper examined the effects of medicines prescribed to each patient on an individualised basis. The model validity of these differing types of study is therefore key to understanding their complete message. You omitted to mention that two of the three non-individualised RCTs with reliable internal validity had inadequate model validity, and so were actually low quality overall. The high-quality evidence base in non-individualised homeopathy therefore comprises a singular RCT – hardly the basis for a decisive conclusion. The new paper recommends a more suitable study design for future RCTs of non-individualised homeopathy.

    And Alan Henness’s comments (14 April) have made me laugh. Based solely on his personal opinion, he has decided I am playing ‘tricks’ with the selection of main outcome measure per trial, querying which outcomes we had ‘changed’. Our selections were made objectively and they are tabulated clearly in the paper. If he knew the relevant RCT papers, Alan Henness would be aware that fewer than half of them defined a primary outcome measure, so there was often nothing for us to ‘change’. As it turned out, our meta-analysis always used the same measure as an originally designated primary outcome.

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