Fresh Support for Homeopathy

Two new studies conclude a review which claimed homeopathy is just a placebo, published in The Lancet, was seriously flawed. George Lewith, professor of health research at Southampton University commented: “The review gave no indication of which trials were analyzed or of the various vital assumptions made about the data. This is not usual scientific practice. If we presume that homeopathy works for some conditions but not others, or change the definition of a ‘larger trial’ the conclusions change. This indicates a fundamental weakness in the conclusions: They are not reliable.”
In August 2005, The Lancet published an editorial entitled “The End of Homeopathy”, prompted by a review comparing clinical trials of homeopathy with trials of conventional medicine. The claim that homeopathic medicines are just placebo was based on six clinical trials of conventional medicine and eight studies of homeopathy, but did not reveal the identity of these trials. The review was criticized for its opacity as it gave no indication of which trials were analyzed and the various assumptions made about the data.
Sufficient detail to enable a reconstruction was eventually published and two recently published scientific papers based on such a reconstruction challenge The Lancet review.
The first study published in the Journal of Clinical Epidemiology concluded, “The meta-analysis results change sensitively to the chosen threshold defining large sample sizes. Because of the high heterogeneity between the trials, Shang’s (The Lancet) results and conclusions are less definite as they had been presented.”
In the second study published in Homeopathy, researchers concluded, “Re-analysis of Shang’s (The Lancet) post-publication data did not support the conclusion that homeopathy is a placebo effect. The conclusion that homeopathy is and that conventional is not a placebo effect was not based on comparative analysis and not justified because of heterogeneity and lack of sensitivity analysis. If we confine ourselves to the predefined hypotheses and the part of the analysis that is indeed comparative, the conclusion should be that quality of homeopathic trials is better than of conventional trials, for all trials (P=0.03) as well as for smaller trials (P=0.003).”
The Lancet review, led by Professor Matthias Egger of the department of social and preventive medicine at the University of Berne, started with 110 matched clinical trials of homeopathy and conventional medicine, reduced these to “higher quality trials” and then to eight and six respectively “larger higher quality trials.” Based on these 14 studies, the review concluded there is “weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions.”
There are a limited number of homeopathic studies so it is quite possible to interpret these data selectively and unfavorably, which is what appears to have been done in The Lancet paper.
This reconstruction casts serious doubts on the review, showing it was based on a series of hidden judgments unfavorable to homeopathy. An open assessment of the current evidence suggests that homeopathy is probably effective for a number of conditions including allergies, upper respiratory tract infections and ‘flu, but more research is desperately needed.
Professor Egger declined to comment on these findings.