... and other stories.
Papers, listed by lead author: K-L
K
Kainz, J.T., Kozel, G., Haidvogl, M., Smolle, J., 1996 Homoeopathic versus placebo therapy of children with warts on the hands: a randomized, double-blind clinical trial Dermatology Vol. 193 no. 4 pp. 318-20
“CONCLUSION: There was no apparent difference between the effects of homoeopathic therapy and placebo in children with common warts under the conditions of this study”
Links: [abstract pubmed]
Kim, L.S., Riedlinger, J.E., Baldwin, C.M., Hilli, L., Khalsa, S.V., Messer, S.A., Waters, R.F., 2005 Treatment of Seasonal Allergic Rhinitis Using Homeopathic Preparation of Common Allergens in the Southwest Region of the US: A Randomized, Controlled Clinical Trial Annals of Pharmacotherapy Vol. 39 no. 4 pp. 617-624
Kleijnen, J., Knipschild, P and ter Riet, G., (1991) Clinical trials of homoeopathy BMJ Vol. 9 no. 302 pp. 316-323
"OBJECTIVE - To establish whether there is evidence of the efficacy of homoeopathy from controlled trials in humans...
CONCLUSIONS - At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials."
CONCLUSIONS -
Links: [abstract - pub med ]:[abstract - BMJ ]:[full text - BMJ, pdf ]
This rather aged paper is one of the homeopathic “usual suspects” that get trotted out at every opportunity as straws to clutch at by homeopathic apologists. As proof of the effectiveness of homeopathy it is pretty flimsy, one would doubt whether the results would be able to fight their way out of a damp paper bag in order to defend the cause, really, this one ought to be able to retire gracefully. Still, it is some of the best evidence they’ve got, so let’s have a look at it.
What the homeopaths say: Proponents tend to cherry pick a few of the more favourable remarks from the body of this meta-analysis while conveniently ignoring others. A popular quote is " The amount of positive evidence even among the best studies came as a surprise to us. Based on this evidence we would be ready to accept that homoeopathy can be efficacious, if only the mechanism of action were more plausible.". “Boo, hiss!” shriek the homeopaths, “they know it works but they can’t bring themselves to admit it”. When, however, the explanatory "...to assume that an infinitesimally diluted substance in an alcoholic solution has pharmacological effects would mean that essential concepts of modern physics would have to be dismissed." is mentioned it all goes quiet and the only sound that can be heard is that of homeopaths with fingers in ears going “La, la, la, can’t hear you”.
In fact not having a plausible mode of action is an almost insurmountable hurdle for homeopathy. This isn't just someone commenting on say, a new antibiotic telling people "we haven't found out how it works yet but we've got a few ideas from the way others do and we have a set route which the investigation will take". It isn't just somebody with a vested interest in the status quo nit picking that "if it isn't 'science' then it can't work, no matter what the evidence says", although that this remark is simply prejudice is what homeopaths would like us to believe. Homeopathy's mechanism isn't just unknown it is, in any practical sense of the word, impossible. This is according to not just "essential concepts of modern physics" but to virtually every other branch of science as well - chemistry, biology, electromagnetics, you name it. If homeopathy were to be proved effective it would contradict most of known science at the most basic of levels - how is it that only homeopaths have noticed this gaping chasm of ignorance, and why aren't they able to prove it?
When considering homeopathy in this way something called the 'simplicity principle' applies. This is really a philosophical version of every day 'common sense', which has ancient roots going back at least to Occam (Sehon, 2010) and, in a nutshell, means that any evidence that homeopathy works must be massively convincing - orders of magnitude more so than for our antibiotic. Needless to say performing only slightly better than a sugar tablet in a few questionable trials doesn't come anywhere close.
Another favourite out of context remark from this paper is "The evidence presented in this review would probably be sufficient for establishing homoeopathy as a regular treatment for certain indications." while declining to mention that the authors had called into question much of that same evidence as a result of questionable methodologies, for example, "Double blinding... has to be checked by asking the patients in which group they believe that they were in during the trial... It is easy to state that a trial was double blind, but patients have many ways to break the code. This might explain small differences in favour of homoeopathy. Double blinding was not checked in any trial of homoeopathy." or bias, for example "When talking to authors of trials we identified at least six trials for which no manuscript had been submitted for publication. It is difficult to discover the true reasons for failure to submit an article for publication, but we think that the (possibly negative) results may have been an important factor in these cases.".
So, the final verdict (and remember, this is one of the best pieces of evidence homeopaths can offer to support their case) is that the conclusion says it all, if you can interpret past the inevitable qualifiers: "At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias".
I'll translate - " poor trial quality and possible bias means there is no evidence that homeopathy works" - keep it simple, that's the motto of Rational Vet Med. Yet another negative trial!
L
Linde, K., et al (1997) Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials Lancet Vol. 350 no. 9081 pp. 834-843 *
BACKGROUND: Homeopathy seems scientifically implausible, but has widespread use. We aimed to assess whether the clinical effect reported in randomised controlled trials of homeopathic remedies is equivalent to that reported for placebo.
INTERPRETATION: The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.
INTERPRETATION: The results of our meta-
What the homeopaths say: Despite the authors’ conclusion that “we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition” the ENHR comment is very up-
Unfortunately however for the homeopaths two subsequent re-analyses (Linde et al, 1999 (below) and Ernst and Pittler, 2000) found that the statistics in this study were flawed and the interpretation of the results had been wildly over-optimistic. Edzard Ernst reported "the reanalysis of Linde et al. can be seen as the ultimate epidemiological proof that homeopathic remedies are, in fact, placebos." and Linde himself stated following a fresh look at the data “We conclude that in the study set investigated, there was clear evidence that studies with better methodological quality tended to yield less positive results." As a further criticism of homoeopathic trials in general he states "in these trials homeopathy was mainly used for mild and chronic conditions for which there are few objective outcome measures."
So, this paper is out of date, has deeply flawed statistics and has been superceded by two subsequent re-analyses both of which found against homeopathy.
Jump back to the “Usual suspects” page for the next devastating weapon in the homeopathic arsenal of damp squibs...
Links: [abstract - pub med ]:[full text - Lancet ]:[full text, pdf, homeovet]:[full text, pdf, swph education.org]
Resonses: [Bandolier]:[Ernst and Barnes - comment in Lancet ]:[CRD DARE analysis]
Linde, K., Melchart, D., (1998) Randomized controlled trials of individualized homeopathy: a state-of-the-art review. J Altern Complement Med. Vol. 4 no.4 pp371-88.
“The results of the available randomized trials suggest that individualized homeopathy has an effect over placebo. The evidence, however, is not convincing because of methodological shortcomings and inconsistencies. Future research should focus on replication of existing promising studies. New randomized studies should be preceded by pilot studies.”
Links: [abstract - pub med ]
Linde, K., Scholz, M., Ramirez, G., et al., (1999) Impact of study quality on outcome in placebo controlled trials of homeopathy J Clin Epidemiol Vol. 52 pp. 631–6
"We investigated the influence of indicators of methodological quality on study outcome in a set of 89 placebo-controlled clinical trials of homoeopathy in three different ways... Studies that were explicitly randomized and were double-blind as well as studies scoring above the cut-points yielded significantly less positive results than studies not meeting the criteria. In the cumulative meta-analyses, there was a trend for increasing effect sizes when more studies with lower-quality scores were added... We conclude that in the study set investigated, there was clear evidence that studies with better methodological quality tended to yield less positive results..."
This is a reinterpretation of the lead author’s earlier work (Linde 1997, above) which completely overturned the, albeit weak, evidence of the original conclusion in favour of homeopathy and reported that the better the quality of the trial, the worse the results were for homeopathy. Homeopaths are always very keen to quote the Linde 1997 paper as irrefutable proof of how jolly teriffic homeopathy is, but always seem to forget the Linde 1999 one -
Linde, K., Wayne Jonas, W., (2005) Are the clinical effects of homoeopathy placebo effects? Lancet, Vol. 366, no. 9503, pp. 2081 - 2082 (this article is a response to Shang et al 2005)
| History of RVM |
| The Best They Can Do |
| The Usual Suspects |
| How to look at evidence |
| CAM journals and evidence |
| Scepticism about homeopathy |
| Arguments |
| Acupuncture references |