Lancet article referred to in Homeopathy: someone should tell the government that there's nothing in it by Ben Goldacre

[Guest guest]

http://www.thelancet.com/journals/lancet/article/PIIS0140673605671772/abstract

Are the clinical effects of homoeopathy placebo effects? Comparative study

of placebo-controlled trials of homoeopathy and allopathy

Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner

D, Egger M

The Lancet - Vol. 366, Issue 9487, 27 August 2005, Pages 726-732

The Lancet 2005; 366:726-732

DOI:10.1016/S0140-6736(05)67177-2

Are the clinical effects of homoeopathy placebo effects? Comparative study

of placebo-controlled trials of homoeopathy and allopathy

Aijing Shang a, Karin Huwiler-Müntener a, Nartey a, Jüni

a b, Stephan Dörig a c, AC Sterne b, Pewsner a d

and Matthias Egger email address a b Corresponding Author Information

Summary

Background

Homoeopathy is widely used, but specific effects of homoeopathic remedies

seem implausible. Bias in the conduct and reporting of trials is a possible

explanation for positive findings of trials of both homoeopathy and

conventional medicine. We analysed trials of homoeopathy and conventional

medicine and estimated treatment effects in trials least likely to be

affected by bias.

Methods

Placebo-controlled trials of homoeopathy were identified by a comprehensive

literature search, which covered 19 electronic databases, reference lists

of relevant papers, and contacts with experts. Trials in conventional

medicine matched to homoeopathy trials for disorder and type of outcome

were randomly selected from the Cochrane Controlled Trials Register (issue

1, 2003). Data were extracted in duplicate and outcomes coded so that odds

ratios below 1 indicated benefit. Trials described as double-blind, with

adequate randomisation, were assumed to be of higher methodological

quality. Bias effects were examined in funnel plots and meta-regression

models.

Findings

110 homoeopathy trials and 110 matched conventional-medicine trials were

analysed. The median study size was 65 participants (range ten to 1573). 21

homoeopathy trials (19%) and nine (8%) conventional-medicine trials were of

higher quality. In both groups, smaller trials and those of lower quality

showed more beneficial treatment effects than larger and higher-quality

trials. When the analysis was restricted to large trials of higher quality,

the odds ratio was 0·88 (95% CI 0·65–1·19) for homoeopathy (eight trials)

and 0·58 (0·39–0·85) for conventional medicine (six trials).

Interpretation

Biases are present in placebo-controlled trials of both homoeopathy and

conventional medicine. When account was taken for these biases in the

analysis, there was weak evidence for a specific effect of homoeopathic

remedies, but strong evidence for specific effects of conventional

interventions. This finding is compatible with the notion that the clinical

effects of homoeopathy are placebo effects.

Affiliations

a Department of Social and Preventive Medicine, University of Berne, Berne,

Switzerland

b Medical Research Council Health Services Research Collaboration,

Department of Social Medicine, University of Bristol, Bristol, UK

c Department of Pharmacology, University of Zürich, Zürich, Switzerland

d Practice Brückfeld, MediX General Practice Network, Berne, Switzerland

Corresponding Author InformationCorrespondence to: Prof Matthias Egger,

Department of Social and Preventive Medicine, University of Berne, Berne,

Switzerland

*********

http://www.guardian.co.uk/medicine/story/0,11381,1556831,00.html>

And

Medics attack use of homeopathy

Heavily diluted solutions are used in homeopathic remedies

A leading medical journal has made a damning attack on homeopathy, saying

it is no better than dummy drugs.

The Lancet says the time for more studies is over and doctors should be

bold and honest with patients about homeopathy's " lack of benefit " .

A Swiss-UK review of 110 trials found no convincing evidence the treatment

worked any better than a placebo.

Advocates of homeopathy maintained the therapy, which works on the

principle of treating like with like, does work.

Continuing dispute

Someone with an allergy, for example, who was using homeopathic medicines

would attempt to beat it with an ultra-diluted dose of an agent that would

cause the same symptoms.

Many previous studies have demonstrated that homeopathy has an effect over

and above placebo

A spokeswoman from the Society of Homeopaths

The row over homeopathy has been raging for years.

In 2002, American illusionist Randi offered $1m to anyone able to

prove, under observed conditions in a laboratory, that homeopathic remedies

can really cure people.

To date, no-one has passed the preliminary tests.

In the UK, homeopathy is available on the NHS. Some argue that it should be

more widely available, while others believe it should not be offered at all.

In 2000, the UK Parliamentary Select Committee on Science and Technology

issued a report on complementary and alternative medicine.

It reported that " any therapy that makes specific claims for being able to

treat specific conditions should have evidence of being able to do this

above and beyond the placebo effect " .

To prove a negative is impossible. But good large studies of homeopathy do

not show a difference

Researcher Professor Matthias Egger

'No better than placebo'

According to Professor Matthias Egger, from the University of Berne, and

Swiss colleagues from Zurich University and a UK team at the University of

Bristol, homeopathy has no such evidence.

They compared 110 trials that looked at the effects of homeopathy versus

placebo with 110 trials of conventional medicines for the same medical

disorders or diseases.

This included trials for the treatment of asthma, allergies and muscular

problems, some large and some small.

For both homeopathy and conventional medicines, the smaller trials of lower

quality showed more beneficial treatment effects than the larger trials.

Illusionist Randi offered a million dollars to anyone able to prove

homeopathy cures

However, when they looked at only the larger, high-quality trials, they

found no convincing evidence that homeopathy worked any better than placebo.

Professor Egger said: " We acknowledge to prove a negative is impossible.

" But good large studies of homeopathy do not show a difference between the

placebo and the homeopathic remedy, whereas in the case of conventional

medicines you still see an effect. "

He said some people do report feeling better after having homeopathy. He

believes this is down to the whole experience of the therapy, with the

homeopath spending a lot of time and attention on the individual.

" It has nothing to do with what is in the little white pill, " he said.

'Research bias'

However, the Lancet also reports that a draft report on homeopathy by the

World Health Organization says the majority of peer-reviewed scientific

papers published over the past 40 years have demonstrated that homeopathy

is superior to placebo in placebo-controlled trials.

HAVE YOUR SAY

What does the medical field have to gain by shooting alternative remedies

down?

London, UK

Send us your comments

Furthermore, it says that homeopathy is equivalent to conventional

medicines in the treatment of illnesses, both in humans and animals.

Professor Edzard Ernst, professor of complementary medicine at the

Peninsula Medical School in Exeter, said the draft WHO report seemed

overtly biased and that all of the trials cited happened to be positive.

" They are not the most rigorous ones, not the most recent, " he said.

A spokeswoman from the Society of Homeopaths said: " Many previous studies

have demonstrated that homeopathy has an effect over and above placebo.

" It has been established beyond doubt and accepted by many researchers,

that the placebo-controlled randomised controlled trial is not a fitting

research tool with which to test homeopathy. "

--------------------------------------------------------

Sheri Nakken, R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

$$ Donations to help in the work - accepted by Paypal account

vaccineinfo@... voicemail US 530-740-0561

(go to http://www.paypal.com) or by mail

Vaccines - http://www.nccn.net/~wwithin/vaccine.htm

Vaccine Dangers On-Line course - http://www.nccn.net/~wwithin/vaccineclass.htm

Homeopathy On-Line course - http://www.nccn.net/~wwithin/homeo.htm

ANY INFO OBTAINED HERE NOT TO BE CONSTRUED AS MEDICAL

OR LEGAL ADVICE. THE DECISION TO VACCINATE IS YOURS AND YOURS ALONE.

******

" Just look at us. Everything is backwards; everything is upside down.

Doctors destroy health, lawyers destroy justice, universities destroy

knowledge, governments destroy freedom, the major media destroy information

and religions destroy spirituality " .... Ellner