This paper examined the state of homeopathic clinical research by critically assessing the overall quality of peer-reviewed, recently published, English-language, homeopathic clinical research in terms of internal, external, and model validity using standard and homeopathic-specific instruments. Further, an international panel of nine experts in research methods and homeopathy to identifed gaps in homeopathic research and prioritize areas for future study.
The team reviewed 99 clinical research studies targeting a wide range of populations and conditions. Studies were conducted in Western and Asian countries, with the largest number (30 percent) conducted in India. Of the 99 studies reviewed,
- 85 were controlled trials;
- 79 of these were randomized.
There were many areas where 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.
Of the 14 observational (cohort) studies, over one-third did not control for important confounders in the outcome analyses. Regarding external validity, adherence was reported in less than a third of studies (n=31). Forty percent of studies (79% of observational studies) did not report on safety. Regarding model validity, fewer than two-thirds of the studies were consistent with homeopathic principles.
The expert panel’s opinion was mixed on whether the homeopathic research literature was missing important populations and/or conditions, and they suggested a variety of priority areas. Panelists also expressed a variety of opinions about the types of homeopathy that should be prioritized for future study but also noted that since homeopathic practice differs by country, each country may have different priorities.
Panelists agreed with the findings of the literature review that the research literature was at least somewhat deficient in all three types of validity. Although the assessment of validity was [by necessity] based only on what was reported, it suggests the need for both better reporting and higher quality research. They recommended the use of reporting guidelines to improve all types of validity, the identification of exemplar studies to help guide researchers to improve internal validity, and, given the limitations of the instruments available to measure external and model validity, that these instruments be validated and configured to provide summary scores.
Finally, substantial discussion addressed the need to bring more research expertise into homeopathic studies. This could be done both by better training homeopathic researchers and by collaborating with experienced conventional medicine research groups.
The authors concluded that the state of homeopathic research could be substantially 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.
One of the fascinating aspects here is that the panel was not asked to deliberate whether – in view of homeopathy’s implausibility and the largely negative clinical evidence – further reseach into the subject is meaningful or desirable.
But by now you probably ask yourself: who are the members of the expert panel? Here they are:
- 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., CHSInstitute.
Two very obvious things should be noted about this panel:
- There are not 9 but only 8 members.
- Almost all are individuals who are pro-homeopathy, and no informed critic of homeopathy was invited.
The latter fact seems important. Anyone who has worked with panels knowns that one can pre-determine the outcome of the deliberations by the choice of the members.
The panel essentially concluded that homeopathic research could be substantially improved. Considering its highly biased composition, this is remarkable. It means that, in fact,
HOMEOPATHIC RESEARCH IS DISMAL.
I have heard from non evidenced based rumours that the 9th expert was a certain Edzard Ernst. However, someone must have forgot to send the email.
Attending any meetings of the expert panel would have been no real issue for Edzard as he is used to trying to stop the CAM tide coming in. A wet suit for Christmas for ‘Edzard the Canute’ would come in handy.
And,
“Finally, we appreciate the guidance of the project’s steering committee: Wayne B. Jonas, MD, President, Healing Works Foundation; and Jennifer Jacobs, MD, MPH.”
https://americanloons.blogspot.com/2017/03/1802-wayne-jonas.html
https://en.m.wikipedia.org/wiki/Wayne_Jonas