“The State of Homeopathic Research” as published by RAND

RAND claims to be “a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.” Recently, RAND has published an extensive report entitled ‘THE STATE OF HOMEOPATHIC RESEARCH“. Here I show you a few interesting passages from this document [the number in square brackets refer to short comments of mine that I appended at the end]:

In this report on the state of homeopathic research, we encapsulate the outcomes of our comprehensive review and the deliberations of our expert panel. These findings and recommendations can guide the homeopathic research community, governmental agencies, and philanthropic organizations in how to best allocate research effort and fund quality and pertinent clinical research endeavors in the field of homeopathy [1].

This research was funded by the Samueli Foundation [2] and carried out by the RAND Research Across Complementary and Integrative Health Institutions (REACH) Center within the Quality Measurement and Improvement Program in RAND Health Care. The RAND REACH Center is a collaboration of researchers across institutions that educate complementary and integrative health practitioners in the United States (www.rand.org/reachcenter); several of these researchers and their students participated in this project…

We examined the state of homeopathic research by critically [3] assessing the overall quality of homeopathic clinical research literature and convening an expert panel to identify gaps in research quality [4] and in areas studied. Our assessment of research quality used a sample of studies from the most comprehensive database of published research on homeopathic research…

There were many areas in which the quality of the studies could be improved. About two-thirds of the 85 controlled trials had either high (42 percent) or unclear (24 percent) risk of bias according to internationally recognized standards for internal validity. Trials with a placebo arm were less likely than those with other comparators to have high risk of bias (29 percent versus 73 percent), primarily because of the ease of blinding patients and outcome assessors. Of the 14 observational (cohort) studies included in our sample, more than one-third did not control for important confounders in the outcome analyses. Regarding external validity, adherence was reported in less than one-third of the studies. Homeopathic consultations took place in 44 studies (the others were studies of routine homeopathy in which all patients received the same remedy [5]); almost half did not describe the experience and training of the practitioners. Forty percent of all studies did not report on safety; 79 percent of observational studies did not. Regarding model validity, which is essential for replicability and interpretability, fewer than two-thirds of the reviewed studies were consistent with homeopathic principles…

Recommendations
Drawing from the outcomes of our homeopathic clinical research literature review and the deliberations of our expert panel, we and the panelists developed the following six recommendations:

1. Funders, researchers, and journal editors and reviewers should require authors to follow the Consolidated Standards of Reporting Trials (CONSORT) and guidelines specific to reporting homeopathic studies, such as the Reporting Data on Homeopathic Treatments (RedHot) criteria for trials, and develop guidelines, as needed. In addition, training institutions should include training on the early use and reference to these guidelines in homeopathic research curricula.
2. All homeopathic studies should proactively monitor and report on adverse events as recommended in CONSORT and several other guidelines for the study of homeopathy [6].
3. Organizations with credibility and acceptability within the homeopathic research community [7] should identify methodological exemplar studies and make them known to researchers, so that these studies can be used to guide future research.
4. Training and support for homeopathic researchers should be increased, and where possible, research teams examining homeopathy should include experienced medical researchers who have an excellent track record for high-quality research. [7] 5. Funders and researchers should consider studies determining the validity of the Critical Appraisal Tool for Homeopathic Intervention Studies (CATHIS) tool as a quality measure for studies of homeopathy.
6. An organization with credibility and acceptability within the homeopathic research community [7] should assemble representative panels of stakeholders to obtain agreement about a small number of areas of focus for future research, with each area reflecting a specific population, treatment or prevention of a condition, and type of homeopathy in a particular country.  These stakeholder panels could also address such research quality issues as determining the level of quality sufficient for making clinical decisions and setting policy guidelines, weighting the relative importance of different aspects of external and model validity, and establishing how to describe homeopathic practice [8]…

Conclusion

The goal of this project was to develop recommendations for the future of homeopathic research to ensure higher-quality evidence on the most relevant uses of homeopathy [9]. We accomplished this goal through a review of recent homeopathic clinical research literature, input from an expert panel, and a synthesis of results from both. We found that the state of homeopathic research could be greatly improved in terms of internal, external, and model validity. Strict adherence to reporting guidelines, with attention to quality criteria during study design, would likely result in most of the needed improvement. However, there is also a need for the homeopathic community to decide where to focus future research in terms of conditions, populations, and types of homeopathy studied. These focus areas could take many forms and should align with the community’s research goals. An appropriate focus (or set of focuses) should also balance answering questions to improve homeopathic treatment with the requirements for coverage by payers and desired inclusion in the broader health care system. [10]

We are grateful for the important feedback from members of our expert panel:

• Iris Bell, M.D., Ph.D., University of Arizona College of Medicine (Retired) and Sonoran University of Health
  Sciences;
• Dan Cherkin, Ph.D., Osher Center for Integrative Health, Department of Family Medicine, University of Washington;
• Roger Chou, M.D., Department of Medical Informatics & Clinical Epidemiology and Department of Medicine, Oregon Health & Science University;
• Katharina Gaertner, MBBS, Research Faculty of Health, University Witten/Herdecke;
• Klaus Linde, M.D., Ph.D., Scientific Coordinator, Technische Universität München, Institute of General Practice and Health Services Research;
• Alexander Tournier, Ph.D., Homeopathy Research Institute and Institute of Complementary and Integrative Medicine, University of Bern;
• Esther van der Werf, M.Sc., Ph.D., Clinical Research Lead, Homeopathy Research Institute, and Honorary Senior Lecturer, Primary
  Care Infection, Bristol Medical School, University of Bristol;
• Harald Walach, Ph.D., CHS Institute. [11]

The project’s steering committee: Wayne B. Jonas, M.D., President, Healing Works Foundation [11]; and Jennifer Jacobs, M.D., M.P.H., Clinical Assistant Professor, Epidemiology, University of Washington School of Public Health [11].

_______________________________

1. The fundamentally important question whether more research of homeopathy is required was studiously ignored.
2. Not exactly an organisation that is known to be impartial.
3. After reading the entire document, I found very little critical input.
4. I am not sure what “gaps in research quality” are; do they mean deficits?
5. I think that’s normally called ‘clinical homeopathy’.
6. Failure to do so is not merely a little lapse but a violation of research ethics!
7. They do not exist.
8. This is not realistic.
9. There is a wide consensus that “relevant uses of homeopathy” do not exist.
10. The crucial question was avoided, whether it is ethical to waste money and effort on researching something that, by a general consensus, is nonsense.
11. Member of our ALTERNATIVE MEDICINE HALL OF FAME!

My final comment: imagine the ‘Flat Earth Society’ convenes an expert panel to decide about the shape of our planet …