MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Generally speaking, Cochrane reviews provide the best (most rigorous, transparent and independent) evidence on the effectiveness of medical or surgical interventions. It is therefore important to ask what they tell us about homeopathy. In 2010, I did exactly that and published it as an overview of the current best evidence. At the time, there were 6 relevant Cochrane reviews. They covered the following conditions: cancer, attention-deficit hyperactivity disorder, asthma, dementia, influenza and induction of labour. And their results were clear: they did not show that homeopathic medicines have effects beyond placebo.

Now a further Cochrane review has been published.

Does it change this situation?

This systematic review assessed the effectiveness and safety of oral homeopathic medicinal products compared with placebo or conventional therapy to prevent and treat acute respiratory tract infections (ARTIs) in children. The researchers conducted extensive literature searches, checked references, and contacted study authors to identify additional studies. They included all double-blind, randomised controlled trials (RCTs) or double-blind cluster-RCTs comparing oral homeopathy medicinal products with identical placebo or self selected conventional treatments to prevent or treat ARTIs in children aged 0 to 16 years.

Eight RCTs of 1562 children receiving oral homeopathic medicinal products or a control treatment (placebo or conventional treatment) for upper respiratory tract infections (URTIs). Four treatment studies examined the effect on recovery from URTIs, and four studies investigated the effect on preventing URTIs after one to three months of treatment and followed up for the remainder of the year. Two treatment and two prevention studies involved homeopaths individualising treatment for children. The other studies used predetermined, non-individualised treatments. All studies involved highly diluted homeopathic medicinal products.

Several key limitations to the included studies were identified, in particular methodological inconsistencies and high attrition rates, failure to conduct intention-to-treat analysis, selective reporting, and apparent protocol deviations. The authors deemed three studies to be at high risk of bias in at least one domain, and many had additional domains with unclear risk of bias. Three studies received funding from homeopathy manufacturers; one reported support from a non-government organisation; two received government support; one was co-sponsored by a university; and one did not report funding support.

Methodological inconsistencies and significant clinical and statistical heterogeneity precluded robust quantitative meta-analysis. Only four outcomes were common to more than one study and could be combined for analysis. Odds ratios (OR) were generally small with wide confidence intervals (CI), and the contributing studies found conflicting effects, so there was little certainty that the efficacy of the intervention could be ascertained.

All studies assessed as at low risk of bias showed no benefit from oral homeopathic medicinal products; trials at uncertain and high risk of bias reported beneficial effects. The authors found low-quality evidence that non-individualised homeopathic medicinal products confer little preventive effect on ARTIs (OR 1.14, 95% CI 0.83 to 1.57). They also found low-quality evidence from two individualised prevention studies that homeopathy has little impact on the need for antibiotic usage (N = 369) (OR 0.79, 95% CI 0.35 to 1.76).

The authors also assessed adverse events, hospitalisation rates and length of stay, days off school (or work for parents), and quality of life, but were not able to pool data from any of these secondary outcomes. There is insufficient evidence from two pooled individualised treatment studies (N = 155) to determine the effect of homeopathy on short-term cure (OR 1.31, 95% CI 0.09 to 19.54; very low-quality evidence) and long-term cure rates (OR 1.01, 95% CI 0.10 to 9.96; very low-quality evidence). Adverse events were reported inconsistently; however, serious events were not reported. One study found an increase in the occurrence of non-severe adverse events in the treatment group.

The authors concluded that pooling of two prevention and two treatment studies did not show any benefit of homeopathic medicinal products compared to placebo on recurrence of ARTI or cure rates in children. We found no evidence to support the efficacy of homeopathic medicinal products for ARTIs in children. Adverse events were poorly reported, so conclusions about safety could not be drawn.

In their paper, the authors state that “there are no established explanatory models for how highly diluted homeopathic medicinal products might work. For this reason, homeopathy remains highly controversial because the key concepts governing this form of medicine are not consistent with the established laws of conventional therapeutics.” In other words, there is no reason why highly diluted homeopathic remedies should work. Yet, remarkably, when asked what conditions responds best to homeopathy, most homeopaths would probably include ARTI of children.

The authors also point out that “The results of this review are consistent with all previous systematic reviews on homeopathy. Funders and study investigators contemplating any further research in this area need to consider whether further research will advance our knowledge, given the uncertain mechanism of action and debate about how the lack of a measurable dose can make them effective. The studies we identified did not use a uniform approach to choosing and measuring outcomes or assigning appropriate time points for outcome measurement. The use of validated symptom scales would facilitate future meta-analyses. It is unclear if there is any benefit from individualised (classical) homeopathy over the use of commercially available products.”

Even though I agree with the authors on most of their views and comment their excellent work, I would be more outspoken regarding the need of further research. In my view, it would be a foolish, wasteful and therefore unethical activity to fund, plan or conduct further research in this area.

10 Responses to A new Cochrane Review of homeopathy: “no evidence to support the efficacy of homeopathic medicinal products”

  • But further research is needed to establish how many angels can sit on the head of a pin, and whether unicorns do their business in the woods.

    Any homeopath, medically qualified or not, who treats a patient without informing them of this work cited above is unethical, and may be a fraudulent criminal seeking to take advantage of the gullible.

    Such unethical behaviour by healthcare professionals has got to stop. Professional regulators have much to answer for.

    • But, but, stutter… Patients love and believe in homeopathy, positively adore it. So let them have their imaginary angels and unicorns. So that I may have their money.

    • Apologies – should have said ‘regulators of health professionals’.
      I am particularly concerned about the GMC who is supposed to regulate doctors, and requires they ‘do their best for patients’.
      That includes obtaining fully informed consent, but most homeopathically inclined registered medical practitioners do not do so.
      They are unethical.

      If any who read this (Peter Fisher?) claim they are not, would they please provide the information sheet they give patients, or any other evidence that patients are fully informed?
      Now, they can add the Cochrane review as above. Bet they don’t. QED.

    • Dr Rawlins: I am sure that your mission to protect the ‘gullible’ public is honourable. Unfortunately for you though the ‘gullible’ public have a say in all of this and regulators are very are of this. I suspect that you would love to be a Drs version of a certain enthusiastic young vet and facilitate a statement similar to the November RCVS statement. I predict that you will encounter considerable opposition from your other board members.

  • If this homeopathy just doesn’t work, and there is not conceivable way that it might given our present knowledge of science, should not the report just come out and say it – Homeopathy does not work and is unethical top use?

    Despite all the pseudo-trials, not one homeopath has come up with an explanation hos there could be possibly a method by which these ultra-diluted substances might work – something which could alter the science we know today so surely the whole idea is junk until someone can come up with a convincing idea of how it might work and a prediction to test.

  • Had they included the innumerable and incoherent blog entries by ‘Greg’, ‘Ilqal, ‘Ulman’ and the other vociferous supporters of idiotic-concepts their conclusion could have been: “further research into homeopathy is unwarranted however research into the degraded mental-processes of adherents would be both productive and hilarious”.

  • Communication of scientific research to the public (especially when dealing with complex issues), is difficult and many scientists struggle to do this well (me included). We tend to express our views as exact as possible, but this involves the risk that the main message is watered-down. In this age of “post-truth politics” (Trump, etc.), this problem becomes increasingly apparent.
    I think that in cases as obvious as the lack for any specific effect of homeopathy, we scientist should take off the kid gloves and tell things as we see them (and, in contrast to the homeopathy believers, have the objective scientific evidence).
    Therefore I agree with Prof. Ernst that the conclusion that further studies are NOT necessary and a WASTE of time and money should have been pointed out much more clearly by the authors.
    Scientists should become more outspoken and should be less afraid to “over-simplify” issues that are so obvious as this one.

  • What was true in 1842 remains true today:

    “If, as must be admitted, no one of Hahnemann’s doctrines is received with tolerable unanimity among his disciples, except the central axiom, Similia similibus curantur; if this axiom itself relies mainly for its support upon the folly and trickery of Hahnemann, what can we think of those who announce themselves ready to relinquish all the accumulated treasures of our art, to trifle with life upon the strength of these fantastic theories? What shall we think of professed practitioners of medicine, if, in the words of Jahr, “from ignorance, for their personal convenience, or through charlatanism, they treat their patients one day Homoeopathically and the next Allopathically;” if they parade their pretended new science before the unguarded portion of the community; if they suffer their names to be coupled with it wherever it may gain a credulous patient; and deny all responsibility for its character, refuse all argument for its doctrines, allege no palliation for the ignorance and deception interwoven with every thread of its flimsy tissue, when they are questioned by those competent to judge and entitled to an answer?

    Such is the pretended science of Homoeopathy, to which you are asked to trust your lives and the lives of those dearest to you. A mingled mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and of artful misrepresentation, too often mingled in practice, if we may trust the authority of its founder, with heartless and shameless imposition. Because it is suffered so often to appeal unanswered to the public, because it has its journals, its patrons, its apostles, some are weak enough to suppose it can escape the inevitable doom of utter disgrace and oblivion. Not many years can pass away before the same curiosity excited by one of Perkins’s Tractors will be awakened at the sight of one of the Infinitesimal Globules. If it should claim a longer existence, it can only be by falling into the hands of the sordid wretches who wring their bread from the cold grasp of disease and death in the hovels of ignorant poverty.

    As one humble member of a profession which for more than two thousand years has devoted itself to the pursuit of the best earthly interests of mankind, always assailed and insulted from without by such as are ignorant of its infinite perplexities and labors, always striving in unequal contest with the hundred-armed giant who walks in the noonday, and sleeps not in the midnight, yet still toiling, not merely for itself and the present moment, but for the race and the future, I have lifted my voice against this lifeless delusion, rolling its shapeless bulk into the path of a noble science it is too weak to strike, or to injure.”

    Oliver Wendell Holmes
    https://biotech.law.lsu.edu/cphl/history/articles/ho_holmes.htm

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