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

This Cochrane 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 included double‐blind randomized clinical trials (RCTs) or double‐blind cluster‐RCTs comparing oral homeopathy medicinal products with placebo or self‐selected conventional treatments to prevent or treat ARTIs in children aged 0 to 16 years.

In this 2022 update, the researchers identified three new RCTs involving 251 children, for a total of 11 included RCTs with 1813 children receiving oral homeopathic medicinal products or a control treatment for ARTIs. All studies focused on upper respiratory tract infections (URTIs), with only one study including some lower respiratory tract infections (LRTIs). Six RCTs examined the effect on URTI recovery, and five RCTs investigated the effect on preventing URTIs after one to four months of treatment. Two treatment and three prevention studies involved homeopaths individualizing treatment. The other studies used predetermined, non-individualized remedies. All studies involved highly diluted homeopathic medicinal products, with dilutions ranging from 1 x 10‐4 to 1 x 10‐200.

Several 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. Three studies were classified as at high risk of bias in at least one domain, and many studies had additional domains with unclear risk of bias. Four studies received funding from homeopathy manufacturers; one study support from a non‐government organization; two studies government support; one study was co‐sponsored by a university; and three studies did not report funding support.

Methodological inconsistencies and significant clinical and statistical heterogeneity precluded robust quantitative meta‐analysis. Only four outcome variables 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, whilst trials at unclear or high risk of bias reported beneficial effects. For the comparison of individualized homeopathy versus placebo or usual care for the prevention of ARTIs, two trials reported on disease severity; due to heterogeneity the data were not combined, but neither study demonstrated a clinically significant difference. For the comparison of non-individualized homeopathy versus placebo or usual care for the prevention of ARTIs, only the outcome recurrence of ARTI was reported by more than one trial. For the comparison of both individualized and non-individualized homeopathy versus placebo or usual care for the treatment of ARTIs, two studies provided data on short‐term cure (OR 1.31, 95% CI 0.09 to 19.54) and long‐term cure (OR 1.01, 95% CI 0.10 to 9.96; very low‐certainty evidence). The studies demonstrated an opposite direction of effect for both outcomes. Six studies reported on disease severity but were not combined as they used different scoring systems and scales. Three studies reported adverse events (OR 0.79, 95% CI 0.16 to 4.03; low‐certainty evidence).

The authors concluded that the “pooling of five prevention and six treatment studies did not show any consistent benefit of homeopathic medicinal products compared to placebo on ARTI recurrence or cure rates in children. We assessed the certainty of the evidence as low to very low for the majority of outcomes. We found no evidence to support the efficacy of homeopathic medicinal products for ARTIs in children. Adverse events were poorly reported, and we could not draw conclusions regarding safety.”

____________________________

These findings are hardly surprising. Will they change the behavior of homeopaths who feel that

  1. children respond particularly well to homeopathy,
  2. ARTIs are conditions for which homeopathy is particularly effective?

I would not hold my breath!

3 Responses to Homeopathy for preventing and treating acute respiratory tract infections in children

  • Of course, it is not the children who “respond particularly well to homeopathy” – but the parents who appreciate the care and attention provided (whilst the ARTI gets better on its own account).
    Homeopaths who do not understand that should retire.

    (P.S. Same goes for other animals ‘treated’ with homeopathy!)

  • Can it be that Cochrane is too “pragmatic” in such reviews? Wouldn’t it be more appropriate to ask who, from a medical ethics point of view, actually approved RCTs with sick children who were consistently treated with placebo? Both in the verum and in the control group?

    All that is shown – once again – is that some change always occurs. For homeopaths to interpret this as a “trend” or “indication” of homeopathy’s own effect is as notorious as it is absurd.

    • 1) the ethics issue is not the remit of a typical Cochrane review; it needs to be addressed differently and by a different body, I think.
      2) homeopaths will always misinterpret such evidence – but this does not mean it is wrong or unnecessary to establish it.

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