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

Yes, there is a new paper on homeopathic Arnica!

And yes, it arrives at a positive conclusion.

How is this possible?

Let’s have a look.

The authors conducted a systematic review and metaanalysis, following a predefined protocol, of all studies on the use of homeopathic Arnica montana in surgery. They included all randomized and nonrandomized studies comparing homeopathic Arnica to a placebo or to another active comparator and calculated two quantitative meta-analyses and appropriate sensitivity analyses.

Twenty-three publications reported on 29 different comparisons. One study had to be excluded because no data could be extracted, leaving 28 comparisons. Eighteen comparisons used placebo controls, nine comparisons an active control, and in one case Arnica was compared to no treatment. The metaanalysis of the placebo-controlled trials yielded an overall effect size of Hedge’s g = 0.18 (95% confidence interval -0.007/0.373; p = 0.059). Active comparator trials yielded a highly heterogeneous significant effect size of g = 0.26. This is mainly due to the large effect size of non-randomized studies, which converges against zero in the randomized trials.

The authors concluded that homeopathic Arnica has a small effect size over and against placebo in preventing excessive hematoma and other sequelae of surgeries. The effect is comparable to that of anti-inflammatory substances.

This review has many remarkable (or should I say, suspect?) features, e.g.:

  • Its authors are famous (or should I say, infamous) advocates of homeopathy not known for their objectivity (including Prof Walach).
  • Some of the trials included in the analysis are unpublished conference proceedings usually only published as an abstract (ref 29).
  • Others were published in journals such as ‘Allgemeine Homoeopathische Zeitung‘ which is unlikely to manage a decent peer-review system (ref 46).
  • Some trials used Arnica in low potencies that contained active molecules, and nobody doubts that active molecules can have effects (ref 32 and 37).
  • One study seems to be a retrospective case-control study (ref 38).
  • The primary endpoints of several studies were not those evaluated in the review (e.g. ref 42).
  • One study used a combination of herbal and homeopathic arnica in the verum group which means the observed effect cannot be attributed to homeopathy (ref 31).

Perhaps the strangest feature relates to the methodology used by the review authors: “Where data were only available in graphs, data were read off the graph by enlarging the display and reading the figures with a ruler.” I have never before come across this method which must be wide open to bias.

Considering all of these odd features, I think that the small effect size over and against placebo in preventing excessive hematoma and other sequelae of surgeries reported by the review authors is most likely due to a range of factors that have nothing whatsoever to do with homeopathy.

So, does the new review show that homeopathic Arnica is “efficacious”? I don’t think so!

9 Responses to A new review of the ‘efficacy’ of homeopathic Arnica by Harald Walach & Co

  • I would like to add some information on the “AHZ – Allgemeine Homöopathische Zeitung”.
    It sounds like a free maganzine you can get at the drug store. However, this is not ture. It is one of the oldest medical magazines we have. Founded in 1832, it is today part of Haugg publishing company which belons to Thieme publishing company, an at least in Germany well known scientifc publisher with lots of national and international reputable scientific magazines. They have editors and a sceintific adivisory board. The eiditor decdes which papers are accepted and which aore not. However, I could not find a hint on a classic peer review approach. This approach within the world of homeopathy may be not so easy to find. Maybe editors plus adivsiory council is already the major fraction of scientific working experts in homeopathy in Germany – but I do not know.

    You can have a look at very old editions of this magazine:
    https://de.wikisource.org/wiki/Allgemeine_hom%C3%B6opathische_Zeitung

    To me it looks scientific in a very honourable way. Looking at that old magazines, I have almost the smell of the archives in the old university libraries I have been when I was much younger in my nose …

    • I did provide a link so that readers can inform themselves. Here is the list of editors (not one of them is a leading scientist)
      Dr. med. D. Albrecht, Ganderkesee
      U. Koch, Hofheim
      Dr. med. C. Lucae, München
      Dr. med. A. Sparenborg-Nolte, Marburg/Lahn
      And this is the scientific board:
      Dr. phil. M. Baschin, Stuttgart
      Dr. sc. nat. S. Baumgartner, Bern
      Dr. med. M. K. H. Elies, Laubach
      Dr. med. U. Fischer, Freiburg
      … and look!!! it includes one of the authors of the review.

      • After Thieme published one of the seminal books criticizing homeopathy in 1991 (Hopff W, Homöopathie kritisch betrachtet), they eventually decided to take homeopathic publications under their wing. They make possible the continued existence of many of them. The fact that it is a comprehensible business model does not change the fact that what is being published here is about the futile search for nothingness.

        The “Allgemeine homöopathische Zeitung” first appeared on July 1, 1932. Homeopaths love fossils.

  • Comment regarding usage of data from graphics:
    yopou wrote:
    Perhaps the strangest feature relates to the methodology used by the review authors: “Where data were only available in graphs, data were read off the graph by enlarging the display and reading the figures with a ruler.” I have never before come across this method which must be wide open to bias.

    We have a problem in the way scientific results are published. When I was active at university, data were only added rarely to the papers. Nowadays, things are different. However, still not all papers give their raw data for independent analysis. I remember a few overview papers where they tried to get the data by means of autmatically analysing the points in graphics turning them into numbers. You won’t get data with high precision that way. However, yccuracy should be OK. Depending on the precision of the method used to measure the the values used in the paper, you may even get a very usable dataset that adds not very much bias.

  • Systematic review of tooth-fairy science is also tooth-fairy science.

  • I’ve not heard of this journal, but one does wonder about its peer review process. Should the paper be retracted?

    • The article homeopathic Arnica was published in Frontiers in Surgery (!) which is part of Frontiers Media SA.

      Frontiers Media SA is a publisher of peer-reviewed open access scientific journals[3] currently active in science, technology, and medicine. It was founded in 2007 by a group of neuroscientists,[4] including Henry and Kamila Markram, and later expanded to other academic fields. Frontiers is based in Lausanne, Switzerland, with other offices in London, Madrid, Seattle and Brussels. All Frontiers journals are published under a Creative Commons Attribution License (CC-BY).

      https://en.wikipedia.org/wiki/Frontiers_Media

      The Wikipedia article has listed a number of controversies, e.g:

      In 2021, a provisionally accepted controversial paper in Frontiers in Pharmacology on COVID-19 and the use of the antiparasitic drug ivermectin was ultimately rejected by the editors as it contained “unsubstantiated claims and violated the journal’s editorial policies”. This has drawn anger among the authors of the paper calling the move “censorship”. Retraction Watch notes that this is not the first time Frontiers already provisionally accepted and then rejected a controversial paper

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