Intended for healthcare professionals

Letters Advice on homoeopathic products

Clothing naked quackery and legitimising pseudoscience

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5960 (Published 21 September 2011) Cite this as: BMJ 2011;343:d5960

The evidence for homeopathy is not positive

Many of the 'great and good' in the world of homeopathy declare no
competing interests, yet this is not true. Nevertheless, we rise to the
challenge to critically evaluate the 5 articles mustered in defence of
their trade.

The meta-analysis by Wiesenauer and Ludtke(1), included 8 RCTs. A re-
analysis(2) of the 4 published placebo-controlled RCTs revealed serious
flaws including: non-validated outcome measures; all the studies
originated from Wiesenauer's own group; lack of independent replication.
Furthermore, relatively low dilutions were employed which contain active
molecules and generate pharmacological effects contrary to ultra-molecular
dilutions.

Taylor et al pooled the data from their own 4 RCTs and found a mean
symptom reduction of 28% for the experimental and 3% for the placebo
groups(3). This article has been criticized repeatedly(4-6). A placebo-
response as low as 3% is puzzling (~30% would be typical). A meta-analysis
of the authors' own studies can hardly be convincing. Moreover, these were
not of homeopathic remedies relying on the "like cures like principle" but
of isopathy, which is based on using causative agents.

The health technology assessment by Bornhoft et al(7) included weak
evidence such as uncontrolled studies. In the "strongest" domain of upper
respiratory tract infections, it included 16 placebo-controlled trials, 8
of which were positive. This unconvincing evidence also lacked critical
input and included many studies of low dilutions.

Bellavite et al(8) state "whether homeopathic high dilutions are
placebos... is still a matter of debate... A general weakness of evidence
derives from lack of independent confirmation of reported trials and from
presence of conflicting results...".

Witt et al evaluated 67 in-vitro experiments(9) and discovered that
"nearly 3/4 of them found a high potency effect". Yet they had to concede
that "no positive result was stable enough to be reproduced by all
investigators".

Thus, this best case for homeopathy is fundamentally flawed and
hopelessly weak. If evidence of efficacy as poor as this was offered for
registration of a new drug, it would not succeed.

References

(1) Wiesenauer M, L?dtke R. A meta-analysis of the homeopathic
treatment of pollinosis with galphimia glauca. Forsch Komplement?rmed
1996; 3(5):230-234.

(2) Ernst E. Homeopathic Galphimia glauca for hay fever: a systematic
review of randomised clinical trials and a critique of a published meta-
analysis. Focus Altern Complement Ther 2011; 16(3):200-203.

(3) Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C, Aitchison TC.
Randomised controlled trial of homoeopathy versus placebo in perennial
allergic rhinitis with overview of four trial series. BMJ 2000; 321:471-
476.

(4) Miller B. Homoeopathy versus placebo in perennial allergic rhinitis.
Statisitics in study were flawed. BMJ 2000; 322(7259):169.

(5) Brown HM. Homoeopathy versus placebo in perennial allergic rhinitis.
Did patients really have allergic rhinitis? BMJ 2000; 322(7259):170-171.

(6) Windeler J. Homoeopathy versus placebo in perennial allergic
rhinitis. Results of study were not convincing in favour nof homoeopathy.
BMJ 2000; 322(7259):170.

(7) Bornh?ft G, Wolf U, von Ammon K, Righetti M, Maxion-Bergemann S,
Baumgartner S et al. Effectiveness, safety and cost-effectiveness of
homeopathy in general practice - summarized health technology assessment.
Forsch Komplementmed 2006; 13(Suppl2):19-29.

(8) Bellavite P, Ortolani R, Pontarolo F, et al. Immunology and
homeopathy. 4. Clinical studies - Part 2. eCAM 2006; 3:397-409.

(9) Witt CM, Bluth M, Albrecht H, Weisshuhn TE, Baumgartner S, Willich
SN. The in vitro evidence for an effect of high homeopathic potencies-a
systematic review of the literature. Complement Ther Med 2007; 15(2):128-
138.

Competing interests: As previously stated

07 October 2011
Susan Bewley
Obstetric consultant
Edzard Ernst, John Garrow, Nick Ross, Les Rose, Michael Baum, James May, Alain Braillon, David Bender
Kings Health Partners, SE1 7EH