Homeopathy: another negative Indian study with a misleading conclusion

Indian homeopaths aimed at evaluating the efficacy of individualized homeopathy (IH) for atopic dermatitis (AD). They conducted a double-blind, randomized, placebo-controlled, short-term, preliminary trial in an Indian homeopathy hospital. Patients were randomized to either IH (n = 30) or identical-looking placebo (n = 30) using computerized randomization and allocation. Outcomes were patient-oriented scoring of AD (PO-SCORAD; primary endpoint), Dermatological Life Quality Index (DLQI) score, and AD burden score for adults (ADBSA; secondary endpoints), measured monthly for 3 months. An intention-to-treat sample was analyzed after adjusting baseline differences.

On PO-SCORAD, improvement was higher in IH against placebo, but nonsignificant statistically (p_{month 1} = 0.433, p_{month 2} = 0.442, p_{month 3} = 0.229). Secondary outcomes were also nonsignificant – both DLQI and ADBSA (p > 0.05). Four adverse events (diarrhea, injury, common cold) were recorded.

The authors concluded that there was a small, but nonsignificant direction of effect towards homeopathy, which renders the trial inconclusive. A properly powered robust trial is indicated.

Thee questions:

1. Why use statistics only to ignore its results?
2. Why discredit research into so-called alternative medicine (SCAM) in this way?
3. Who on earth would publish such misleading conclusions?

This article was published in Complementary Medicine Research which claims to be an international peer-reviewed journal that aims to bridge the gap between conventional and complementary/alternative medicine on a sound scientific basis, promoting their mutual integration. It boasts that “experts of both conventional medicine and complementary/alternative medicine cooperate on the journal’s editorial board, ensuring a high standard of scientific quality”. Its editor is Harald Walach who we have met several times before.

I had a look at the long list of members of the editorial board and was unable to see many ‘experts in conventional medicine’. If that is so, the journal’s peer review process is bound to turn into a farcical procedure where any rubbish will pass.

The journal reminds authors that “published research must comply with internationally-accepted standards for research practice and reporting.” I believe that the internationally accepted standards of research reporting include something about not misleading the public by claiming that the absence of an effect is a small effect in favor of homeopathy. By revealing that there was no significant effect, the authors of this study demonstrate that IH was not effective as a treatment of AD. It is in my mind unethical to try to disguise this result by making it look like a small positive effect or claiming the result was inconclusive.

High standard of scientific quality?

No, quite the opposite!