Research in Homeopathy, Clinical research in homeopathy. Levels of research evidence

2. Clinical research in homeopathy. Levels of research evidence

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In this section, we present three forms of research evidence in clinical homeopathy that have been pursued. Conventionally, there is a hierarchy of scientific evidence in which meta-analyses of published research are placed at the top, the original research (in the form of clinical trials) are placed below and, on a lower level, clinical observational studies are placed third.

Clinical outcome surveys

Comprehensive meta-analyses of clinical trials in homeopathy

The widely accepted 'gold standard' for assessing the efficacy of a treatment is a meta-analysis or systematic review of randomised controlled trials (RCTs). Since 1991 there have been six published meta-analyses of homeopathic RCTs, and all but one conclude (with some qualifications) that homeopathy has an effect greater than that of placebo.

The most thorough summary of this evidence was provided in a meta-analysis of placebo-controlled trials of homeopathy in human subjects, published by Linde et al in the Lancet in 1997.¹ A total of 89 double-blind, randomised, placebo-controlled trials was included in the analysis. The results strongly supported a statistically significant difference overall between homeopathy and placebo.¹ This conclusion is compatible with those in four of the five other meta-analyses of research in homeopathy (Table 1). A key issue is that very few individual medical conditions have been the subject of rigorous investigation in homeopathy, and so there are little research data to review in a systematic way. It was for this reason that Linde et al came to the additional conclusion that there is 'insufficient evidence ... that homeopathy is clearly efficacious for any single clinical condition'. The most recent meta-analysis approached this issue in a unique way, by limiting the main analysis to just 8 large clinical trials of homeopathy and interpreting their (negative) results as somehow representative of the whole of homeopathy and for any medical condition.⁸¹

Importantly, all such meta-analyses and systematic reviews have concluded that more research in homeopathy is warranted. This is a view strongly supported by the British Homeopathic Association and the Faculty of Homeopathy. It should be highlighted too that, since 1997, focused meta-analyses of published trials in four specific medical conditions - childhood diarrhoea,² hayfever,³ post-operative ileus⁴ and rheumatoid arthritis⁵ - have provided support for the treatment effectiveness of homeopathy.

	2. Clinical research in homeopathy. Levels of research evidence
Photograph Details	In this section, we present three forms of research evidence in clinical homeopathy that have been pursued. Conventionally, there is a hierarchy of scientific evidence in which meta-analyses of published research are placed at the top, the original research (in the form of clinical trials) are placed below and, on a lower level, clinical observational studies are placed third. Comprehensive meta-analyses of clinical trials in homeopathy Clinical research in homeopathy with positive findings Selected randomised clinical trials of homeopathy Comments on homeopathy research Clinical outcome surveys Comprehensive meta-analyses of clinical trials in homeopathy The widely accepted 'gold standard' for assessing the efficacy of a treatment is a meta-analysis or systematic review of randomised controlled trials (RCTs). Since 1991 there have been six published meta-analyses of homeopathic RCTs, and all but one conclude (with some qualifications) that homeopathy has an effect greater than that of placebo. The most thorough summary of this evidence was provided in a meta-analysis of placebo-controlled trials of homeopathy in human subjects, published by Linde et al in the Lancet in 1997.¹ A total of 89 double-blind, randomised, placebo-controlled trials was included in the analysis. The results strongly supported a statistically significant difference overall between homeopathy and placebo.¹ This conclusion is compatible with those in four of the five other meta-analyses of research in homeopathy (Table 1). A key issue is that very few individual medical conditions have been the subject of rigorous investigation in homeopathy, and so there are little research data to review in a systematic way. It was for this reason that Linde et al came to the additional conclusion that there is 'insufficient evidence ... that homeopathy is clearly efficacious for any single clinical condition'. The most recent meta-analysis approached this issue in a unique way, by limiting the main analysis to just 8 large clinical trials of homeopathy and interpreting their (negative) results as somehow representative of the whole of homeopathy and for any medical condition.⁸¹ Importantly, all such meta-analyses and systematic reviews have concluded that more research in homeopathy is warranted. This is a view strongly supported by the British Homeopathic Association and the Faculty of Homeopathy. It should be highlighted too that, since 1997, focused meta-analyses of published trials in four specific medical conditions - childhood diarrhoea,² hayfever,³ post-operative ileus⁴ and rheumatoid arthritis⁵ - have provided support for the treatment effectiveness of homeopathy.	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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