Homeopathy is not an effective treatment for any health condition, report concludesBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1478 (Published 16 March 2015) Cite this as: BMJ 2015;350:h1478
All rapid responses
There is some evidence that individualised homeopathic intervention is more effective than placebo, report could have concluded
As recognised by Dana Ullman elsewhere in these Comments, the timing of the Australian NHMRC report’s publication prevented its consideration of a high-quality systematic review and meta-analysis of randomised controlled trials in individualised homeopathic treatment, published in December 2014 . Using the NHMRC’s own description of an evidence base, dated 2013 , it is reasonable to expect that the new paper’s evidence, if available in the timeframe, would have been judged as: ‘A small body of good-quality evidence has been appropriately meta-analysed and found a significant difference in favour of homeopathy’. The NHMRC’s conclusion about individualised homeopathy would therefore properly have been: ‘Based on the body of evidence evaluated in this review, there is some evidence that homeopathy is more effective than placebo’.
The recent meta-analysis paper’s own main conclusion was: ‘Medicines prescribed in individualised homeopathy may have small, specific treatment effects’. This conclusion, reflecting evidence in individualised homeopathy across a broad spectrum of medical conditions, transcends the condition-specific analysis that is the essence of the NHMRC report. Thus, while the evidence in homeopathy for any given medical condition is currently deficient, there is [to borrow the NHMRC’s vocabulary] some evidence that individualised homeopathic intervention is more effective than placebo.
This up-to-date perspective on homeopathy’s clinical research evidence must be brought firmly into the consideration of homeopathy’s role in NHS healthcare. Its practitioners employ individualised homeopathy for the majority of their patients; they thereby treat the person as a whole, including a specified medical condition or conditions.
1. Mathie RT, Lloyd SM, Legg LA, Clausen J, Moss S, Davidson JRT, Ford I. Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Systematic Reviews 2014; 3: 142.
2. NHMRC. Effectiveness of homeopathy for clinical conditions: overview report. Appendix C: Criteria for development of evidence statements; 2013: p279.
Competing interests: The writer is employed by the British Homeopathic Association with the key aim of clarifying and extending an evidence base in homeopathy. Along with colleagues from within and outwith homeopathy, including statisticians at the University of Glasgow, he is the first author of the cited meta-analysis paper herein. In their write-up of that paper, all authors applied the normal high standards of scientific method in the conduct of the work and of complete and transparent reporting.
Dr. Sikorsky cites a definition of the homeopathic doctrine of similars. I am very familiar with this.
What would be much more interesting is to see any evidence of even mediocre quality to support the claim that like cures like as a common principle, let alone a sole universal basis of cure as purist homeopaths would have it.
It is, after all, based on Samuel Hahnemann's conjecture that cinchona bark cures malaria because the symptoms of cinchonism are like those of malaria, an idea which was refuted with the discovery of the plasmodium falciparum parasite something around a century ago,.
Competing interests: No competing interests
Strangely, here we have an article & a study that is entirely inconsistent with the experience of patients around the world who use Homeopathic Medicines on a daily basis. Furthermore, it is strikingly discordant with the experience of medically qualified Homeopathic doctors who prescribe Homeopathic Medicines on a daily basis.
As a GP, I am delighted and relieved to have Homeopathic Medicine as another therapeutic option in my toolbox when I am treating patients. Time and time again I see improvements after Homeopathic treatment – often when both the patient and I are least expecting it.
Others have critiqued the study in question and it is clear that important evidence was omitted, that the evidence included was used somewhat selectively and thus the skewed conclusions are hardly surprising. It was unfortunately a flawed piece of work and I doubt if an analysis of this standard would be acceptable in any other area of Medicine.
More “real world” research is clearly needed to explore further this fascinating, cost-effective, clinically effective, hugely popular and extremely safe treatment option that is used by many doctors and patients both here in the UK and around the world.
Competing interests: No competing interests
What this BMJ article conveniently failed to report and what the Australian government’s press material failed to acknowledge was that ANY study that was less than 150 subjects was deemed "inadequate" by this report, and thus, the dozens of studies that have shown the efficacy of homeopathy in treating many ailments were totally thrown out and ignored, including many “high quality” randomized double-blind, placebo controlled trials that have been published in The Lancet, BMJ, Cancer, Pediatrics, Chest, Rheumatology, Pediatrics Infectious Disease Journal, British Journal of Clinical Pharmacology, European Journal of Pediatrics, and many others!
Further, unless there were at least THREE studies conducted by THREE separate groups of researchers, with each study having over 150 subjects, the results were deemed to be "UNRELIABLE."
By not acknowledging THESE arbitrary guidelines, the Australian government showed “bad faith” because they seem to be purposefully seeking to misinform the medical community and the general public about the results of this report.
Based on these definitions of what "adequate" and "reliable" research, EVERY complementary and alternative treatment would be deemed to be INEFFECTIVE and even UNPROVEN (this is what has been said and written about homeopathy), including all of acupuncture, Chinese medicine, and virtually every Western botanical medicine.
Further, the VAST majority of drugs on the market today would also be deemed to be INEFFECTIVE and UNPROVEN.
The Australian government's report on homeopathy was not published in a peer-review journal. Instead, it was stacked with people with known antagonism to homeopathy.
A better, more accurate review of research was just published in late 2014 in a journal that specializes in meta-analyses and reviews of clinical research.
A 2014 meta-analysis of homeopathy is the FIRST to evaluate the way that homeopathy is actually practiced by homeopaths.
This is the first review of homeopathic research to evaluate the efficacy of using INDIVIDUALLY chosen homeopathic medicines . This research has concluded that in evaluating the highest quality research only that those patients given a homeopathic medicine were twice as likely to get a therapeutic benefit as those given a placebo.
Further, the authors of this meta-analysis asserted that FOUR of these FIVE ‘global’ systematic reviews of clinical homeopathic research reached the conclusion that, with important caveats , the homeopathic intervention probably differs from placebo [3-6]
1. Robert T Mathie*, Suzanne M Lloyd, Lynn A Legg, Jürgen Clausen, Sian Moss,Jonathan RT Davidson and Ian Ford. Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Systematic Reviews 2014, 3:142 doi:10.1186/2046-4053-3-142. http://www.systematicreviewsjournal.com/content/3/1/142
2. Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB: Impact of study quality on outcome in placebo-controlled trials of homeopathy. J Clin Epidemiol 1999, 52:631–636.
3. Kleijnen J, Knipschild P, ter Riet G: Clinical trials of homoeopathy. BMJ 1991, 302:316–323.
4. Boissel JP, Cucherat M, Haugh M, Gauthier E: Critical literature review on the effectiveness of homoeopathy: overview of data from homoeopathic medicine trials. In Homoeopathic Medicine Research Group, Report of the Commission of the European Communities, Directorate-General XII – Science, Research and Development, Directorate E – RTD Actions. Brussels, Belgium: Life Sciences and Technologies – Medical Research; 1996.
5. Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB: Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997, 350:834–843.
6. Cucherat M, Haugh MC, Gooch M, Boissel JP: Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. Eur J Clin Pharmacol 2000, 56:27–33
Competing interests: I am a practicing homeopath who has also written several books on the subject and published other colleagues books on the subject.
Mr Shyan Goh
Would appear to require some basic education in Homeopathic Medicine.
Similia similibus curantur definition | Drugs.com
www.drugs.com › Professionals › Medical Dictionary
Definition: The homeopathic concept expressing the law of similars (literally, “likes are cured by likes”), the doctrine that any drug capable of producing morbid symptoms in the healthy will remove similar symptoms occurring as an expression of disease.
Dilution of the Medicines used by Dr Samuel Hahnemann, a Physician, Chemist, Translator, in order to reduce their unpleasant side-effects was indeed found to reduce the side effects and an empirical scientific observation was made of the beneficial effect being maintained and even augmented.
Digoxin toxicity can cause xanthopsia as well as cardiac arrythmia, another wonderful homeopathic medicine in common medical use.
I thank Mr Goh for the opportunity to clarify matters and suggest he researches any unfamiliar subject he may choose to comment on.
Competing interests: NHS GP
I would like to address Dr Andrew Sikorski's assertions in his recent rapid response where he stated the following:
"But this is Homeopathic Medicine: 'treat like with like'...as in prescribing the amphetamine Ritalin for hyperactive children. Most readers of the BMJ would probably be more familiar with Ritalin, a most excellent example of Homeopathic prescribing."
Unless he practices an unorthodox form of homeopathy (a bit of tautology here, I know), I find his statement potentially misleading
Treating 'like with like' is in fact a very common principle amongst many traditional medicine throughout the world, particularly with Asian and North American ethnic culture. The characteristics of homeopathy that differentiate it from other traditional medicine is in fact Hahnemann's doctrine in which the therapeutic substance in question undergoes serial dilution (potentisation) to 30C (although modern conventional standard nowadays uses 12C) so that there is no longer any molecule left in the theoretically infinitely diluted solution.
Therefore, Dr Sikorski's statement runs into 2 problems:
1. that he is promoting a different form of homeopathy (if he is saying treating like with like without potentisation), or
2. he is suggesting that NOVARTIS the maker of Ritalin has the major component Methylphenidate hydrochloride in homeopathic doses, (since advertised doses of 10 mg to 40 mg per tablet cannot be considered as homeopathic concentration in any interpretation)
Perhaps Dr Sikorski would like to qualify his statement, or correct them
Competing interests: I do not practice homeopathy, nor do I advocate it.
The only part of this report I can agree with is the statement:
“people who are considering whether to use homeopathy should first get advice from a registered health practitioner and in the meanwhile keep taking any prescribed treatments.”
Few would disagree that a good history, examination and investigation where indicated should be the starting point of all medical and complementary consultations.
There is little more that I can agree with in this article.
The article cautions that: cautioned that “people who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence.” however it fails to acknowledge the vast toxicity and harm that may be experienced by patients taking these "evidence based" conventional treatments. It would be interesting to compare but it seems highly probable that the incidence and risk of harm to patients from conventional treatment is substantially greater than for those who chose to use homeopathy.
The article also totally fails to note that a great many people chose homeopathy for conditions where conventional medicine either has little to offer them, or the treatments have a high burden of side effects.
For many of these patients the benefits of a holistic consultation and non toxic remedies which give them some improvement, even if no greater than the placebo effect, but at low cost and low risk of side effects provides welcome improvement.
As so often when homeopathy is being slated, the positive studies are criticized for being too small or methodologically flawed, clearly more research is needed but meanwhile lets accept this is an imperfect world and hang onto a system of medicine which is popular with patients and gives many relief from chronic dis-ease.
Competing interests: No competing interests
Of course homeopathy works. The only thing to be determined is HOW it works. Even if the authors of this article think that it only works by placebo, what they then mean is that the homeopathic consultation and the belief of the homeopathic doctor is the source of healing, rather than the medication. And if that is the case, then conventional medicine has much to learn from homeopathy. And if it's the medicine, then doctors have even more to learn from homeopathy. Thus the worst thing to do is to trash homeopathy in any way.
Competing interests: I am a member of the Faculty of Homeopathy
The authoritative tone of this article's title and content would seem to provide a clear, definitive and reasoned answer to draw a line under a hotly debated issue.
I welcome scientific research which unequivocally proves there is no beneficial effect from Homeopathic Medicine and would be amongst the first to stop using it if this were to be the case, ditto acupuncture.
Looking at the raw data and review design this article actually does nothing less than entrench an unscientific, prejudiced, biased and bigoted short-sighted opinion of Homeopathic treatments. Concerns with the review identified thus far can be found at 2, 3.
Not only is significant eligible research ignored, an arbitrary unsubstantiated study size chosen by the authors to cherry pick the least effective published research, but also the recommendation in the review conclusion commending further quality research has been air brushed out of existence. Were this a study of conventional medical interventions Peter Gotzsche, Ben Goldacre and Fiona Godlee amongst many others would rightly be up in arms and having kittens at such a blatant demonstration of standard spin practices they have previously roundly decried for providing exactly the conclusions expected by scientific research's commissioners.
Meanwhile questioning the conventional prescribing of statins at night, for example, is met with abhorrence despite the dismal evidence for this practice, based on tiny studies 4.
But this is Homeopathic Medicine: 'treat like with like'...as in prescribing the amphetamine Ritalin for hyperactive children. Most readers of the BMJ would probably be more familiar with Ritalin, a most excellent example of Homeopathic prescribing.
There has been an inappropriate and vehement level of negative reporting on Homeopathy for some time. Homeopathy is a safe and extremely cost effective form of medicine which works, is used by millions of patients worldwide, is of clinical value at the consulting coal face often after standard treatment in secondary care has failed and has been routinely used safely to the benefit of suffering patients, alongside usual practice, throughout Europe for over two Centuries. There is valid RCT research in the medical and veterinary fields 5,6.
Whilst the history of medicine is littered with fashions which were contemporary scientific cutting edge "must do's" Homeopathic Medicine has stood the (some would say ultimate) test of time. Some placebo? Why the antagonism to Homeopathy being recognised as the popular, safe, effective, individualised medicine it is and to being more widely used alongside usual medical practice?
The old chestnuts: 'It doesn't work'; 'it can't work'; 'there's nothing to it, and that's it' demonstrate unscientific, closed, dogmatic, thinking of the highest order and are no longer tenable.
One further double blind RCT assessing Homeopathic Medicine with Fluoxetine was published 2 weeks ago. A study size of 133 would be readily dismissed in Australia, but what do you think of significant P values? 7.
You are invited to remain open-minded, inquisitive, scientific , sceptical and reminded medicine is a healing craft incorporating science with compassion for the benefit of patients, whilst sadly being bundled together with iatrogenicity.
The experience of privatising health provision in New Zealand proved medicine is recalcitrant to being treated as a business, and that's a story you can read in this weekend's BMJ 8.
MBBS MRCGP FFHom
8. BMJ 2015;350:h1502
Competing interests: Sceptical NHS physician utilising conventional and complementary techniques in General Practice.
The report includes 57 systematic reviews, and these include in all 176 original publications (not 225) (1). I have looked closer at these, and find that 160 describe a comparison of one or more homeopathic remedies with either placebo or other drugs. The conclusion is therefore quite clear in this area: The homeopathic medicine itself has no effect on health conditions, whether they are prescribed by homeopaths or doctors.
It is unfortunate that the Australians have not been stringent enough with regard to concepts. Their conclusion applies to the 160 studies on homeopathic medicinal products (remedies), but they use their findings to make a statement about homeopathy in general which is a "package" of care (the homeopathic medicinal product is one of several components), and this "package" has been the subject of little research.
A quick glance at the remaining 16 original publications that actually has the homeopathic "package" as its focus, seems to show that ten showed better effectiveness of homeopathy, five showed no difference, and the last showed poorer efficacy of homeopathy when compared with conventional treatment. The methodological quality of these 16 studies were either not specified or was classified to be low.
The most important message we can take from this report is that the highly relevant question from a patient perspective: "Will I be helped by seeing a homeopath?" is far from explored well enough.
A more accurate conclusion to draw from the Australian report is therefore: We do not know whether patients are helped by seeing a homeopath, but a reported improvement is not due to the homeopathic medicinal product.
Competing interests: No competing interests