Research in Homeopathy, Issues and controversies

4. Issues and controversies

Research reviews

Clinical trials

Research reviews

Professor Iris Bell
Evidence-based homeopathy ⁶⁰
Professor Bell's review grapples with key issues, such as the fact that trial results seldom reflect the dramatic and sustained improvements that homeopathic practitioners often see in their patients in everyday practice, and how to improve standards in homeopathic research. The paper makes the point that we need more observational data from real-world homeopathic practice to guide optimal study design, and have greater emphasis on homeopathic considerations rather than allopathic pharmaceutical research concepts. We should adopt patient-centred outcome measures, such as global well-being, rather than merely disease-specific scoring systems. Such views coincide with our own philosophy of research development in homeopathy (see Comments on clinical research in homeopathy).

Dr Wayne Jonas
Critical overview of homeopathy ⁶¹
Dr Jonas includes an overview of those clinical conditions for which there is systematic research evidence in homeopathy. RCTs have consistently shown homeopathy to be effective for the treatment of influenza, allergies, post-operative ileus and childhood diarrhoea. There is a lack of conclusive evidence on the effectiveness of homeopathy for most medical conditions, however. Homeopathy deserves an open-minded opportunity to demonstrate its value by using evidence-based principles. In a number of ways, this approach to the research literature reflects our own independent comprehensive analysis.¹⁰

University of York
Research evidence in homeopathy ⁶²
This publication is principally an overview of all the published systematic reviews and meta-analyses in homeopathic research. The main section of the paper tackles the issue of treatment effectiveness. The paper concludes: 'There are currently insufficient data ... to recommend homeopathy as a treatment for any specific condition'. But it is the cumulative evidence from the individual published trials that provides more appropriate evidence about the effectiveness of homeopathy in at least a few medical conditions (comprehensive analysis ¹⁰). Also, the review fails to mention one of Linde's conclusions: that the clinical effects of homeopathy are unlikely to be due to placebo.¹

The paper separately examined reviews on individualised (classical) homeopathy. One of these reviews indicated that homeopathic remedies might be superior to conventional drug therapy for rheumatoid arthritis and for otitis media in children. ⁶³

Shang et al.
Meta-analysis published in The Lancet, 2005 ⁸¹
The main results from this study are summarised elsewhere on our website. The paper's conclusions - that the clinical effects of homeopathy are probably those of placebo - are not supported by the data presented. Given the heterogeneity of homeopathy trials, it is very unlikely that the design and methods of just 8 (selected mainly because of their large patient sample and therefore 'high quality') can be representative of 110. Moreover, the paper gives no clue about the identity of the 8 trials of homeopathy and the 6 of conventional medicine that were selected for the key analysis: whether they were mainly therapeutic or prophylactic, for example, and whether the homeopathic interventions were classical, 'clinical' or complex homeopathy, or isopathy. Knowledge of these would potentially make a great difference to the inferences that should be drawn.

There are a number of additional concerns in the way the paper approaches homeopathy trials: for example, its criteria of study quality do not reflect the homeopathic relevance of the clinical outcome/s measured; in addition, placebo-controlled design may not have been appropriate in the trials of individualised homeopathy.⁸² In other words, standard assessment criteria are insufficient to gauge 'high quality' in homeopathy trials - a large sample of patients does not necessarily endow a homeopathy study with high methodological quality.

Most independent scientific observers would regard The Lancet paper's analysis as inconclusive in its results and opaque in its methods and reporting. And it has the limitations of any analysis of clinical research in homeopathy that attempts to group together all homeopathic conventions of treatment and all medical conditions that have been investigated. A comprehensive analysis of that type can merely make overall conclusions and may miss specific areas of therapeutic importance - the authors themselves highlight (but dismiss) the fact that 8 trials of homeopathy in upper respiratory tract infections have strongly positive findings overall. It is for this very reason that we and others have analysed the homeopathic research literature by focusing instead on individual clinical trials and their findings.¹⁰ ⁶¹

	4. Issues and controversies
Photograph Details	Research reviews Professor Iris Bell Dr Wayne Jonas University of York Shang et al Clinical trials Fibromyalgia Chronic fatigue syndrome Asthma Arnica in hand surgery Research reviews *Professor Iris Bell* Evidence-based homeopathy ⁶⁰ Professor Bell's review grapples with key issues, such as the fact that trial results seldom reflect the dramatic and sustained improvements that homeopathic practitioners often see in their patients in everyday practice, and how to improve standards in homeopathic research. The paper makes the point that we need more observational data from real-world homeopathic practice to guide optimal study design, and have greater emphasis on homeopathic considerations rather than allopathic pharmaceutical research concepts. We should adopt patient-centred outcome measures, such as global well-being, rather than merely disease-specific scoring systems. Such views coincide with our own philosophy of research development in homeopathy (see Comments on clinical research in homeopathy). *Dr Wayne Jonas* Critical overview of homeopathy ⁶¹ Dr Jonas includes an overview of those clinical conditions for which there is systematic research evidence in homeopathy. RCTs have consistently shown homeopathy to be effective for the treatment of influenza, allergies, post-operative ileus and childhood diarrhoea. There is a lack of conclusive evidence on the effectiveness of homeopathy for most medical conditions, however. Homeopathy deserves an open-minded opportunity to demonstrate its value by using evidence-based principles. In a number of ways, this approach to the research literature reflects our own independent comprehensive analysis.¹⁰ *University of York* Research evidence in homeopathy ⁶² This publication is principally an overview of all the published systematic reviews and meta-analyses in homeopathic research. The main section of the paper tackles the issue of treatment effectiveness. The paper concludes: 'There are currently insufficient data ... to recommend homeopathy as a treatment for any specific condition'. But it is the cumulative evidence from the individual published trials that provides more appropriate evidence about the effectiveness of homeopathy in at least a few medical conditions (comprehensive analysis ¹⁰). Also, the review fails to mention one of Linde's conclusions: that the clinical effects of homeopathy are unlikely to be due to placebo.¹ The paper separately examined reviews on individualised (classical) homeopathy. One of these reviews indicated that homeopathic remedies might be superior to conventional drug therapy for rheumatoid arthritis and for otitis media in children. ⁶³ *Shang et al.* Meta-analysis published in The Lancet, 2005 ⁸¹ The main results from this study are summarised elsewhere on our website. The paper's conclusions - that the clinical effects of homeopathy are probably those of placebo - are not supported by the data presented. Given the heterogeneity of homeopathy trials, it is very unlikely that the design and methods of just 8 (selected mainly because of their large patient sample and therefore 'high quality') can be representative of 110. Moreover, the paper gives no clue about the identity of the 8 trials of homeopathy and the 6 of conventional medicine that were selected for the key analysis: whether they were mainly therapeutic or prophylactic, for example, and whether the homeopathic interventions were classical, 'clinical' or complex homeopathy, or isopathy. Knowledge of these would potentially make a great difference to the inferences that should be drawn. There are a number of additional concerns in the way the paper approaches homeopathy trials: for example, its criteria of study quality do not reflect the homeopathic relevance of the clinical outcome/s measured; in addition, placebo-controlled design may not have been appropriate in the trials of individualised homeopathy.⁸² In other words, standard assessment criteria are insufficient to gauge 'high quality' in homeopathy trials - a large sample of patients does not necessarily endow a homeopathy study with high methodological quality. Most independent scientific observers would regard The Lancet paper's analysis as inconclusive in its results and opaque in its methods and reporting. And it has the limitations of any analysis of clinical research in homeopathy that attempts to group together all homeopathic conventions of treatment and all medical conditions that have been investigated. A comprehensive analysis of that type can merely make overall conclusions and may miss specific areas of therapeutic importance - the authors themselves highlight (but dismiss) the fact that 8 trials of homeopathy in upper respiratory tract infections have strongly positive findings overall. It is for this very reason that we and others have analysed the homeopathic research literature by focusing instead on individual clinical trials and their findings.¹⁰ ⁶¹	Table of contents Homeopathy: the great debate Clinical research in homeopathy Veterinary homeopathy Issues and controversies Mechanism of action Is homeopathy safe? Is homeopathy cost effective? BHA/Faculty’s research strategy References Research discussion forum C O N T A C T U S S I T E M A P H O M E
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