Intended for healthcare professionals

Rapid response to:

Head To Head

Should doctors recommend homeopathy?

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3735 (Published 14 July 2015) Cite this as: BMJ 2015;351:h3735

Rapid Response:

Should doctors recommend homeopathy? The evidence is not a ‘black or white’ issue

So, impasse remains the state of affairs: polarised opinions and comments continue to dominate both sides of the argument. In the head-to-head dialogue, Edzard Ernst reinforces the dichotomy: ‘Homeopaths invariably find flaws in reports that produce [negative] results they don’t like’, failing to note that exactly the same problem exists amongst anti-homeopathy opinion. My personal comment would be: those who decry homeopathy invariably find flaws in reports that produce [positive] results they don’t like.

But hope may be at hand, for Edzard Ernst also states, ‘One can always say there are flaws in this or that systematic review. There will never be a flawless scientific endeavour, by definition. There are always flaws and caveats.’ Honest recognition of that truism should be at the heart of all subsequent debate on the subject of evidence in homeopathy.

Take, for example, the systematic review and meta-analysis of randomised controlled trials (RCTs) of individualised homeopathy, which was published in December 2014 [1]. It was cited by both head-to-head protagonists, and also by Alan Henness in his posted comment here (15 July): he accurately cited the published abstract’s conclusions: ‘Medicines prescribed in individualised homeopathy may have small, specific treatment effects. ..The low or unclear overall quality of the evidence prompts caution in interpreting the findings. New high-quality RCT research is necessary to enable more decisive interpretation.’

Alan Henness expresses difficulty in understanding how that systematic review’s conclusions can be considered ‘essentially positive’. By this comment, he appears to accept its overall tenor, which is a helpful development.

The fact of the matter currently is that, based on state-of-the-art meta-analysis, there is some reliable evidence from RCTs that individually prescribed homeopathic medicines have a small effect that is greater than that of placebos; that evidence is by no means clear-cut, for the overall quality of the RCTs is low or unclear [1]. Also, addressing criticism of the protocol-based exclusion of one trial that concerned Edzard Ernst personally, a later-tested inclusion of that trial did not change the conclusion of the meta-analysis [2].

This evidence debate is not a ‘black or white’ issue: it has shades of grey that should properly affect its tone. Even homeopathy’s ‘bête noire’, the 2005 Lancet study by Shang et al. [3], actually contains data that support a small, statistically significant, effect of individualised homeopathy compared to placebo [1]. That is why the conclusion of the 2014 meta-analysis paper also contains the statement: ‘Findings are consistent with sub-group data available in a previous “global” systematic review’.

Can everyone now – please! – begin to move beyond this seemingly perpetual impasse of dogmatic opinion by reflecting the full spectrum of reliable scientific evidence in homeopathy, irrespective of whether that evidence is positive, negative or non-conclusive?

References:
1. Mathie RT, Lloyd SM, Legg LA, et al. Randomised placebo-controlled trials of indvidualised homeopathic treatment: systematic review and meta-analysis. Syst Rev 2014; 3: 142.
2. Mathie RT, Lloyd SM, Legg LA, et al. Meta-analysis of randomised controlled trials (RCTs) of individualised homeopathy: sensitivity of results to using original authors’ ‘primary outcome measure’. http://www.britishhomeopathic.org/wp-content/uploads/2015/01/BHA-16-Jan-...
3. Shang A, Huwiler-Müntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366: 726–732.

Competing interests: I am first author of the systematic review and meta-analysis of randomised controlled trials of individualised homeopathic treatment, published in December 2014.

17 July 2015
Robert T Mathie
Research Development Adviser
British Homeopathic Association
29 Park Street West, Luton, LU1 3BE