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Gaertner K, Ulbrich-Zürni S, Baumgartner S, Walach H, Frass M, Weiermayer P. Systematic reviews and meta-analyses in Homeopathy: Recommendations for summarising evidence from homeopathic intervention studies (Sum-HomIS recommendations). Complement Ther Med 2023; 79:102999. [PMID: 37898390 DOI: 10.1016/j.ctim.2023.102999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/16/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Mainly due to the use of different inclusion criteria and quality assessments, systematic reviews (SRs) and meta-analyses (MAs) with homeopathic intervention studies (HOMIS) have shown inconsistent results. We aimed to build recommendations for "Summarizing evidence from Homeopathic Intervention Studies" (Sum-HomIS recommendations) in order to approach standardization. METHODS Against the background of a framework-project to update the evidence from homeopathic intervention studies, we launched an expert panel on how to assess the quality of HOMIS and how to summarize evidence from HOMIS. The results of a literature review and the expert communications in advance of the panel as well as the consensus from the discussions are presented here. We added specific considerations for homeopathic veterinary research. RESULTS On top of the general guidelines when planning a review we report five basic Sum-HomIS recommendations. These are: 1) A broad literature search including special archives and consideration of so-called grey-literature; 2) The inclusion of controlled observational studies alongside randomized controlled trials; 3) The choice of a clear clinical research question in the terms that, if possible, the review project includes studies with predominantly homogeneous populations, interventions, comparators and outcomes (PICOs); 4) The use of a global quality assessment including the assessment of external, model and internal validity; 5) A summary of evidence using the GRADE-approach if the body of evidence is sufficiently large and homogenous or a descriptive summary if it is not so. CONCLUSIONS We present recommendations for designing, conducting, and reporting SRs and MAs with HOMIS.
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Affiliation(s)
- Katharina Gaertner
- Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, DE-58313 Herdecke, Germany
| | - Susanne Ulbrich-Zürni
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany
| | - Stephan Baumgartner
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland
| | - Harald Walach
- Next Society Institute, Kazimieras Simonavicius University, Vilnius, Lituania; Change Health Institute, Berlin, Germany
| | - Michael Frass
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany; em. Medical University of Vienna, Department of Medicine I, A-1090 Vienna, Austria; Institute for Homeopathic Research, Columbusgasse 20, A-1100 Vienna, Austria
| | - Petra Weiermayer
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany.
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Hamre HJ, Glockmann A, von Ammon K, Riley DS, Kiene H. Efficacy of homoeopathic treatment: Systematic review of meta-analyses of randomised placebo-controlled homoeopathy trials for any indication. Syst Rev 2023; 12:191. [PMID: 37805577 PMCID: PMC10559431 DOI: 10.1186/s13643-023-02313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/08/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Since 1997, several meta-analyses (MAs) of placebo-controlled randomised efficacy trials of homoeopathy for any indication (PRETHAIs) have been published with different methods, results and conclusions. To date, a formal assessment of these MAs has not been performed. The main objective of this systematic review of MAs of PRETHAIs was to evaluate the efficacy of homoeopathic treatment. METHODS The inclusion criteria were as follows: MAs of PRETHAIs in humans; all ages, countries, settings, publication languages; and MAs published from 1 Jan. 1990 to 30 Apr. 2023. The exclusion criteria were as follows: systematic reviews without MAs; MAs restricted to age or gender groups, specific indications, or specific homoeopathic treatments; and MAs that did not assess efficacy. We searched 8 electronic databases up to 14 Dec. 2020, with an update search in 6 databases up to 30 April 2023. The primary outcome was the effect estimate for all included trials in each MA and after restricting the sample to trials with high methodological quality, according to predefined criteria. The risk of bias for each MA was assessed by the ROBIS (Risk Of Bias In Systematic reviews) tool. The quality of evidence was assessed by the GRADE framework. Statistical analyses were performed to determine the proportion of MAs showing a significant positive effect of homoeopathy vs. no significant difference. RESULTS Six MAs were included, covering individualised homoeopathy (I-HOM, n = 2), nonindividualised homoeopathy (NI-HOM, n = 1) and all homoeopathy types (ALL-HOM = I-HOM + NI-HOM, n = 3). The MAs comprised between 16 and 110 trials, and the included trials were published from 1943-2014. The median trial sample size ranged from 45 to 97 patients. The risk of bias (low/unclear/high) was rated as low for three MAs and high for three MAs. Effect estimates for all trials in each MA showed a significant positive effect of homoeopathy compared to placebo (5 of 5 MAs, no data in 1 MA). Sensitivity analyses with sample restriction to high-quality trials were available from 4 MAs; the effect remained significant in 3 of the MAs (2 MAs assessed ALL-HOM, 1 MA assessed I-HOM) and was no longer significant in 1 MA (which assessed NI-HOM). DISCUSSION The quality of evidence for positive effects of homoeopathy beyond placebo (high/moderate/low/very low) was high for I-HOM and moderate for ALL-HOM and NI-HOM. There was no support for the alternative hypothesis of no outcome difference between homoeopathy and placebo. The available MAs of PRETHAIs reveal significant positive effects of homoeopathy beyond placebo. This is in accordance with laboratory experiments showing partially replicable effects of homoeopathically potentised preparations in physico-chemical, in vitro, plant-based and animal-based test systems. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020209661. The protocol for this SR was finalised and submitted on 25 Nov. 2020 and registered on 26 Dec. 2020.
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Affiliation(s)
- H J Hamre
- Institute for Applied Epistemology and Medical Methodology at Witten/Herdecke University (IFAEMM), Freiburg, Germany.
- Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany.
| | - A Glockmann
- Institute for Applied Epistemology and Medical Methodology at Witten/Herdecke University (IFAEMM), Freiburg, Germany
| | - K von Ammon
- Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany
| | - D S Riley
- Maryland University of Integrative Health (MUIH), Laurel, MD, USA
- Homeopathic Pharmacopoeia Convention of the United States (HPCUS), Southeastern, PA, USA
| | - H Kiene
- Institute for Applied Epistemology and Medical Methodology at Witten/Herdecke University (IFAEMM), Freiburg, Germany
- Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany
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Gaertner K, von Ammon K, Fibert P, Frass M, Frei-Erb M, Klein-Laansma C, Ulbrich-Zuerni S, Weiermayer P. Recommendations in the design and conduction of randomised controlled trials in human and veterinary homeopathic medicine. Complement Ther Med 2023; 76:102961. [PMID: 37393961 DOI: 10.1016/j.ctim.2023.102961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are an established research method to investigate the effects of an intervention. Several recent systematic reviews and meta-analyses of RCTs with homeopathic interventions have identified shortcomings in design, conduct, analysis, and reporting of trials. Guidelines for RCTs in homeopathic medicine are lacking. OBJECTIVES This paper aims to fill this gap in order to enhance the quality of RCTs in the field of homeopathy. METHODS Identification of the homeopathy-specific requirements for RCTs by reviewing literature and experts' communications. Systematization of the findings using a suitable checklist for planning, conducting, and reporting RCTs, namely the SPIRIT statement, and high-quality homeopathy RCTs as examples. Cross-checking of the created checklist with the RedHot-criteria, the PRECIS criteria, and a qualitative evaluation checklist. Consideration of the REFLECT statement and the ARRIVE Guidelines 2.0 for veterinary homeopathy. RESULTS Recommendations for future implementation of RCTs in homeopathy are summarized in a checklist. Alongside, identified useful solutions to the issues encountered when designing and conducting homeopathy RCTs are presented. CONCLUSIONS The formulated recommendations present guidelines additional to those in the SPIRIT checklist, on how to better plan, design, conduct, and report RCTs in homeopathy.
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Affiliation(s)
- Katharina Gaertner
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland; Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, DE-58313 Herdecke, Germany
| | - Klaus von Ammon
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland
| | - Philippa Fibert
- Department of Psychology and Pedagogic Science, St Mary's University, Twickenham, UK
| | - Michael Frass
- em. Medical University of Vienna, Department of Medicine I, A-1090 Vienna, Austria; Institute for Homeopathic Research, Columbusgasse 20, A-1100 Vienna, Austria
| | - Martin Frei-Erb
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland
| | - Christien Klein-Laansma
- Louis Bolk Institute, Health and Nutrition, Kosterijland 3-5, NL-3981 AJ Bunnik, the Netherlands
| | | | - Petra Weiermayer
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany.
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Gaertner K, Loef M, Frass M, Mittal R, Khurana A, Manchanda R, von Ammon K, Frei-Erb M, Walach H, Baumgartner S. Bibliography of Homeopathic Intervention Studies (HOMIS) in Human Diseases. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:14-21. [PMID: 36190509 DOI: 10.1089/jicm.2022.0523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: Homeopathy (HOM) is a therapeutic method, which is widely used by patients and medical professionals. The medical conditions as well as the homeopathic medical products investigated vary strongly. There is an extensive amount of research, and this necessitates a bibliography that comprehensively presents the entire body of clinical evidence grouped according to medical conditions. Design: Thirty-seven online sources as well as print libraries were searched for HOM and related terms in eight languages (1980 to March 2021). We included studies that compared a homeopathic medicine or intervention with a control regarding the therapeutic or preventive outcome of a disease (classified according to International Classification of Diseases-10). The data were extracted independently by two reviewers and analyzed descriptively. Results: A total of 636 investigations met the inclusion criteria, of which 541 had a therapeutic and 95 a preventive purpose. Seventy-three percent were randomized controlled trials (n = 463), whereas the rest were non-randomized studies (n = 173). The leading comparator was placebo (n = 400). The type of homeopathic intervention was classified as multi-constituent or complex (n = 272), classical or individualized (n = 176), routine or clinical (n = 161) and isopathic (n = 19), or various (n = 8). The potencies ranged from 1X (dilution of -10,000) to 10 M (100-10.000). The included studies explored the effect of HOM in 223 medical indications. We present the evidence in an online database. Conclusions: This bibliography maps the status quo of clinical research in HOM. The data will serve for future targeted reviews, which may focus on the most studied conditions and/or homeopathic medicines, clinical impact, and the risk of bias of the included studies.
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Affiliation(s)
- Katharina Gaertner
- Institute of Integrative Medicine, University of Witten/Herdecke, Herdecke, Germany
| | - Martin Loef
- Change Health Science Institute, Berlin, Germany
| | - Michael Frass
- Institute for Homeopathic Research, Vienna, Austria.,Scientific Society for Homeopathy, Koethen, Germany
| | - Renu Mittal
- Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, New Delhi, India
| | - Anil Khurana
- Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, New Delhi, India
| | - Rajkumar Manchanda
- Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, New Delhi, India
| | - Klaus von Ammon
- Scientific Society for Homeopathy, Koethen, Germany.,Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Martin Frei-Erb
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | | | - Stephan Baumgartner
- Institute of Integrative Medicine, University of Witten/Herdecke, Herdecke, Germany.,Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
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Ghosh P, Ganguly S, Mukherjee SK, Dutta S, Shaikh AR, Ali SS, Singh NK, Bhattacharya P, Koley M, Saha S. Individualized Homeopathic Medicines in Treatment of Hyperuricemia: Evaluation by Double-Blind, Randomized, Placebo-Controlled Trial. HOMEOPATHY 2022; 112:85-96. [PMID: 36122588 DOI: 10.1055/s-0042-1751272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hyperuricemia (HU) is a major health issue in India and across the globe. It increases the disease burden and hampers quality of life. This study was aimed at exploring the effects of individualized homeopathic medicines (IHMs) against placebo in the treatment of HU. METHODS This double-blind, randomized, placebo-controlled trial was conducted on 60 patients suffering from HU in the outpatient department of D. N. De Homoeopathic Medical College and Hospital, Kolkata. Each patient received either IHMs or identical-looking placebos, along with advice on dietary modifications irrespective of codes. Serum uric acid (SUA) level was the primary outcome measure; the HU quality of life questionnaire (HUQLQ) and the Measure Yourself Medical Outcome Profile version 2 (MYMOP-2) were the secondary outcomes; all measured at baseline, and every month, up to 3 months. Group differences were examined by two-way (split-half) repeated-measures analysis of variance after adjusting for baseline differences. Significance level was set at p ≤0.05, two-tailed. RESULTS The intention-to-treat sample (n = 58) was analyzed. Between-group differences in SUA levels (F 1, 56 = 13.833, p <0.001), HUQLQ scores (F 1, 56 = 32.982, p <0.001) and MYMOP-2 profile scores (F 1, 56 = 23.873, p <0.001) were statistically significant, favoring IHMs against placebos, with medium to large effect sizes. Calcarea carbonica and Pulsatilla nigricans were the most frequently prescribed medicines. No serious adverse events were reported from either of the groups. CONCLUSION IHMs showed significantly better results than placebos in reducing SUA levels and improving quality of life in patients suffering from HU. TRIAL REGISTRATION CTRI/2019/10/021503; UTN: U1111-1241-1431.
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Affiliation(s)
- Priyanka Ghosh
- Department of Organon of Medicine and Homoeopathic Philosophy, D. N. De Homoeopathic Medical College and Hospital; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, Kolkata, West Bengal, India
| | - Subhasish Ganguly
- Department of Organon of Medicine and Homoeopathic Philosophy, D. N. De Homoeopathic Medical College and Hospital; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, Kolkata, West Bengal, India
| | - Shyamal Kumar Mukherjee
- Department of Community Medicine, D. N. De Homoeopathic Medical College and Hospital; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, Kolkata, West Bengal, India
| | - Souvik Dutta
- Department of Organon of Medicine and Homoeopathic Philosophy, D. N. De Homoeopathic Medical College and Hospital; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, Kolkata, West Bengal, India
| | - Abdur Rahaman Shaikh
- Department of Practice of Medicine, D. N. De Homoeopathic Medical College and Hospital; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, Kolkata, West Bengal, India
| | - Sk Swaif Ali
- Department of Practice of Medicine, Mahesh Bhattacharya Homoeopathic Medical College and Hospital, Howrah, Govt. of West Bengal; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, Howrah, West Bengal, India
| | - Navin Kumar Singh
- Department of Repertory, The Calcutta Homoeopathic Medical College and Hospital; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, Kolkata, West Bengal, India
| | - Pulakendu Bhattacharya
- Department of Organon of Medicine and Homoeopathic Philosophy, D. N. De Homoeopathic Medical College and Hospital; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, Kolkata, West Bengal, India
| | - Munmun Koley
- Department of Homoeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, West Bengal, under Department of Health & Family Welfare, Govt. of West Bengal, West Bengal, India
| | - Subhranil Saha
- Department of Repertory, D. N. De Homoeopathic Medical College and Hospital; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, Kolkata, West Bengal, India
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Doesburg P, Andersen JO, Scherr C, Baumgartner S. Empirical investigation of preparations produced according to the European Pharmacopoeia monograph 1038. Eur J Pharm Sci 2019; 137:104987. [DOI: 10.1016/j.ejps.2019.104987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 11/29/2022]
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Viksveen P, Fibert P, Relton C. Homeopathy in the treatment of depression: a systematic review. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Porto Puerta IE, Porto Cortés IE, Díaz Caballero A. Aplicaciones de la homeopatía en Odontología: revisión de la literatura. ACTA ODONTOLÓGICA COLOMBIANA 2018. [DOI: 10.15446/aoc.v8n1.70358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción: la homeopatía es una terapia que utiliza sustancias naturales para tratar diversas enfermedades, bajo el principio de la similitud, es decir, la causa de la enfermedad también puede curarla. Su alta popularidad en los últimos años se debe a que esta no produce efectos adversos, como sí lo hace la terapia alopática. En el campo de la odontología surge como una terapia complementaria exitosa. Objetivo: describir las aplicaciones más importantes de la homeopatía en odontología, según la literatura. Metodología: se realiza revisión de literatura incluyendo investigaciones originales, casos clínicos, revisiones de narrativas y sistemáticas en Med-line, Pub- Med, Scielo, Latindex, Redalyc y Google académico. No se aplicaron restricciones en el idioma ni en el tiempo de publicación. Resultados: se encuentran y se describen múltiples aplicaciones y bene cios de la homeopatía en odontología, como en la ca- riología, en los pre y postoperatorios, en la disminución del dolor y estrés del paciente, entre otras, resaltando su e cacia y mecanismo de acción. Conclusión: el uso de la ho- meopatía en odontología se considera importante debido a las múltiples aplicaciones en el campo odontológico y por los bene cios de su práctica. Sin embargo, debido a la escaza literatura existente, se recomiendan mayores investigaciones para demostrar su e cacia, además, con el n de descubrir más de sus múltiples aplicaciones.
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Mathie RT, Van Wassenhoven M, Rutten ALB, Klein-Laansma CT, Eizayaga J, Pla I Castellsagué A, Jong MC, Manchanda RK, Dantas F, Oberbaum M, Frye J, Roniger H, Baumgartner S, van Haselen R, Nicolai T, Fisher P. Model validity of randomised placebo-controlled trials of non-individualised homeopathic treatment. HOMEOPATHY 2017; 106:194-202. [PMID: 29157469 DOI: 10.1016/j.homp.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/23/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The comprehensive systematic review of randomised placebo-controlled trials (RCTs) in homeopathy requires examination of a study's model validity of homeopathic treatment (MVHT) as well as its risk of bias (extent of reliable evidence). OBJECTIVE To appraise MVHT in those RCTs of non-individualised homeopathy that an associated investigation had judged as 'not at high risk of bias'. DESIGN Systematic review. METHODS An assessment of MVHT was ascribed to each of 26 eligible RCTs. Another 49 RCTs were ineligible due to their high risk of bias. MAIN OUTCOME MEASURES MVHT and the prior risk of bias rating per trial were merged to obtain a single overall quality designation ('high', 'moderate', 'low'), based on the GRADE principle of downgrading. RESULTS The trials were rated as 'acceptable MVHT' (N = 9), 'uncertain MVHT' (N = 10) and 'inadequate MVHT' (N = 7); and, previously, as 'reliable evidence' (N = 3) and 'non-reliable evidence' (N = 23). The 26 trials were designated overall as: 'high quality' (N = 1); 'moderate quality' (N = 18); 'low quality' (N = 7). CONCLUSION Of the 26 RCTs of non-individualised homeopathy that were judged 'not at high risk of bias', nine have been rated 'acceptable MVHT'. One of those nine studies was designated 'high quality' overall ('acceptable MVHT' and 'reliable evidence'), and is thus currently the only reported RCT that represents best therapeutic practice as well as unbiased evidence in non-individualised homeopathy. As well as minimising risk of bias, new RCTs in this area must aim to maximise MVHT and clarity of reporting.
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Affiliation(s)
- Robert T Mathie
- Homeopathy Research Institute, 142 Cromwell Road, London SW7 4EF, UK.
| | - Michel Van Wassenhoven
- Belgian Homeopathic Medicines Registration Committee, FAMHP (Federal Agency for Medicines and Health Products), Belgium.
| | | | | | - José Eizayaga
- Department of Homeopathy, Maimonides University, Buenos Aires, Argentina.
| | | | - Miek C Jong
- Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands; Department of Health Sciences, Mid-Sweden University, Sundsvall, Sweden; National Information and Knowledge Centre for Integrative Medicine, The Netherlands.
| | | | - Flávio Dantas
- Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil.
| | | | - Joyce Frye
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Helmut Roniger
- Royal London Hospital for Integrated Medicine, London, UK.
| | | | | | | | - Peter Fisher
- Royal London Hospital for Integrated Medicine, London, UK.
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Mathie RT, Ramparsad N, Legg LA, Clausen J, Moss S, Davidson JRT, Messow CM, McConnachie A. Randomised, double-blind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev 2017; 6:63. [PMID: 28340607 PMCID: PMC5366148 DOI: 10.1186/s13643-017-0445-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/24/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A rigorous systematic review and meta-analysis focused on randomised controlled trials (RCTs) of non-individualised homeopathic treatment has not previously been reported. We tested the null hypothesis that the main outcome of treatment using a non-individualised (standardised) homeopathic medicine is indistinguishable from that of placebo. An additional aim was to quantify any condition-specific effects of non-individualised homeopathic treatment. METHODS Literature search strategy, data extraction and statistical analysis all followed the methods described in a pre-published protocol. A trial comprised 'reliable evidence' if its risk of bias was low or it was unclear in one specified domain of assessment. 'Effect size' was reported as standardised mean difference (SMD), with arithmetic transformation for dichotomous data carried out as required; a negative SMD indicated an effect favouring homeopathy. RESULTS Forty-eight different clinical conditions were represented in 75 eligible RCTs. Forty-nine trials were classed as 'high risk of bias' and 23 as 'uncertain risk of bias'; the remaining three, clinically heterogeneous, trials displayed sufficiently low risk of bias to be designated reliable evidence. Fifty-four trials had extractable data: pooled SMD was -0.33 (95% confidence interval (CI) -0.44, -0.21), which was attenuated to -0.16 (95% CI -0.31, -0.02) after adjustment for publication bias. The three trials with reliable evidence yielded a non-significant pooled SMD: -0.18 (95% CI -0.46, 0.09). There was no single clinical condition for which meta-analysis included reliable evidence. CONCLUSIONS The quality of the body of evidence is low. A meta-analysis of all extractable data leads to rejection of our null hypothesis, but analysis of a small sub-group of reliable evidence does not support that rejection. Reliable evidence is lacking in condition-specific meta-analyses, precluding relevant conclusions. Better designed and more rigorous RCTs are needed in order to develop an evidence base that can decisively provide reliable effect estimates of non-individualised homeopathic treatment.
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Affiliation(s)
| | - Nitish Ramparsad
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynn A Legg
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | | | - Sian Moss
- Homeopathy Research Institute, London, UK
| | - Jonathan R T Davidson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Claudia-Martina Messow
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Thomas ET, Clark J, Glasziou P. Publication and outcome reporting of homeopathy trials registered in ClinicalTrials.gov. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/fct.12278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth T Thomas
- Faculty of Health Sciences and Medicine; Bond University; 14 University Drive Robina QLD 4226 Australia
| | - Justin Clark
- Faculty of Health Sciences and Medicine; Centre for Research in Evidence-Based Practice; Bond University; 14 University Drive Robina QLD 4226 Australia
| | - Paul Glasziou
- Faculty of Health Sciences and Medicine; Centre for Research in Evidence-Based Practice; Bond University; 14 University Drive Robina QLD 4226 Australia
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Jacobs J, Taylor JA. A randomized controlled trial of a homeopathic syrup in the treatment of cold symptoms in young children. Complement Ther Med 2016; 29:229-234. [PMID: 27912951 DOI: 10.1016/j.ctim.2016.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is little evidence that the decongestant, antihistamine, or cough suppressant medications commonly used to treat cold symptoms in preschool children are effective. One option for treating cold symptoms in young children is with homeopathy. This study was conducted to determine if a homeopathic syrup was effective in treating cold symptoms in preschool children. METHODS Children 2-5 years old diagnosed with an upper respiratory tract infection were randomized to receive a commercial homeopathic cold syrup or placebo. Parents administered the study medication as needed for 3days. The primary outcome was change in symptoms one hour after each dose. Parents also assessed the severity of each of the symptoms of runny nose, cough, congestion and sneezing at baseline and twice daily for 3days, using a 4-point rating scale. A composite cold score was calculated by combining the values for each of the four symptoms. RESULTS Among 261 eligible participants, data on 957 doses of study medication in 154 children were analyzed. There was no significant difference in improvement one hour after the dose for any symptom between the two groups. Analysis of twice daily data on the severity of cold symptoms compared to baseline values found that improvements in sneezing, cough and the composite cold score were significantly greater at both the first and second assessments among those receiving the cold syrup compared to placebo recipients. CONCLUSION The homeopathic syrup appeared to be effective in reducing the severity of cold symptoms in the first day after beginning treatment.
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Affiliation(s)
- Jennifer Jacobs
- Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, United States.
| | - James A Taylor
- Department of Pediatrics, School of Public Health and Community Medicine, University of Washington, Seattle, WA, United States
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Fibert P. Case report of two siblings with multi- morbidities receiving homeopathic treatment for one year. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mathie RT. Controlled clinical studies of homeopathy. HOMEOPATHY 2015; 104:328-32. [DOI: 10.1016/j.homp.2015.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/12/2015] [Accepted: 05/20/2015] [Indexed: 12/26/2022]
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Mathie RT, Van Wassenhoven M, Jacobs J, Oberbaum M, Roniger H, Frye J, Manchanda RK, Terzan L, Chaufferin G, Dantas F, Fisher P. Model validity of randomised placebo-controlled trials of individualised homeopathic treatment. HOMEOPATHY 2015; 104:164-9. [PMID: 26143448 DOI: 10.1016/j.homp.2015.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 01/16/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Though potentially an important limitation in the literature of randomised controlled trials (RCTs) of homeopathy, the model validity of homeopathic treatment (MVHT) has not previously been systematically investigated. OBJECTIVE As an integral part of a programme of systematic reviews, to assess MVHT of eligible RCTs of individualised homeopathic treatment. METHODS From 46 previously identified papers in the category, 31 papers (reporting a total of 32 RCTs) were eligible for systematic review and were thus the subject of the study. For each of six domains of assessment per trial, MVHT was judged independently by three randomly allocated assessors from our group, who reached a final verdict by consensus discussion as necessary. RESULTS Nineteen trials were judged overall as 'acceptable' MVHT, nine as 'uncertain' MVHT, and four as 'inadequate' MVHT. CONCLUSIONS These results do not support concern that deficient MVHT has frequently undermined the published findings of RCTs of individualised homeopathy. However, the 13 trials with 'uncertain' or 'inadequate' MVHT will be a focus of attention in supplementary meta-analysis. New RCTs of individualised homeopathy must aim to maximise MVHT and to enable its assessment through clear reporting.
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Affiliation(s)
- Robert T Mathie
- British Homeopathic Association, Hahnemann House, 29 Park Street West, Luton LU1 3BE, UK.
| | - Michel Van Wassenhoven
- Belgian Homeopathic Medicines Registration Commission, FAMHP, Rue Taille Madame 23, B-1450 Chastre, Belgium.
| | - Jennifer Jacobs
- School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195, USA.
| | - Menachem Oberbaum
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Helmut Roniger
- Royal London Hospital for Integrated Medicine, 60 Great Ormond Street, London WC1N 3HR, UK.
| | - Joyce Frye
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Raj K Manchanda
- Central Council for Research in Homeopathy, Department of AYUSH, Ministry of Health & Family Welfare, Government of India, New Delhi 110058, India.
| | - Laurence Terzan
- Boiron, 20 Rue de la Liberation, 69110 Sainte Foy-lès-Lyon, France.
| | | | - Flávio Dantas
- Department of Clinical Medicine, Universidade Federal de Uberlândia, Uberlândia, Brazil.
| | - Peter Fisher
- Royal London Hospital for Integrated Medicine, 60 Great Ormond Street, London WC1N 3HR, UK.
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Mathie RT, Lloyd SM, Legg LA, Clausen J, Moss S, Davidson JRT, Ford I. Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev 2014; 3:142. [PMID: 25480654 PMCID: PMC4326322 DOI: 10.1186/2046-4053-3-142] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/12/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A rigorous and focused systematic review and meta-analysis of randomised controlled trials (RCTs) of individualised homeopathic treatment has not previously been undertaken. We tested the hypothesis that the outcome of an individualised homeopathic treatment approach using homeopathic medicines is distinguishable from that of placebos. METHODS The review's methods, including literature search strategy, data extraction, assessment of risk of bias and statistical analysis, were strictly protocol-based. Judgment in seven assessment domains enabled a trial's risk of bias to be designated as low, unclear or high. A trial was judged to comprise 'reliable evidence' if its risk of bias was low or was unclear in one specified domain. 'Effect size' was reported as odds ratio (OR), with arithmetic transformation for continuous data carried out as required; OR > 1 signified an effect favouring homeopathy. RESULTS Thirty-two eligible RCTs studied 24 different medical conditions in total. Twelve trials were classed 'uncertain risk of bias', three of which displayed relatively minor uncertainty and were designated reliable evidence; 20 trials were classed 'high risk of bias'. Twenty-two trials had extractable data and were subjected to meta-analysis; OR = 1.53 (95% confidence interval (CI) 1.22 to 1.91). For the three trials with reliable evidence, sensitivity analysis revealed OR = 1.98 (95% CI 1.16 to 3.38). CONCLUSIONS Medicines prescribed in individualised homeopathy may have small, specific treatment effects. Findings are consistent with sub-group data available in a previous 'global' systematic review. The low or unclear overall quality of the evidence prompts caution in interpreting the findings. New high-quality RCT research is necessary to enable more decisive interpretation.
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CORE-Hom: A powerful and exhaustive database of clinical trials in homeopathy. HOMEOPATHY 2014; 103:219-23. [DOI: 10.1016/j.homp.2014.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/11/2014] [Accepted: 07/15/2014] [Indexed: 11/18/2022]
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Saha S, Koley M, Mahoney ER, Hibbard J, Ghosh S, Nag G, Purkait R, Mondal R, Kundu M, Patra S, Ali SS, Arya JS, Choubey G. Patient activation measures in a government homeopathic hospital in India. J Evid Based Complementary Altern Med 2014; 19:253-9. [PMID: 24972592 DOI: 10.1177/2156587214540175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The American Patient Activation Measure-22 questionnaire (PAM-22) quantifies the knowledge, skills, and confidence essential to manage own health and health care. It is a central concept in chronic illness care models, but studied sparsely in homeopathic hospitals. PAM-22 was translated into Bengali and a cross-sectional study was undertaken in chronically ill 417 patients visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, India. Response rate was 90.41%. Data were analyzed using Rasch rating scale model with Winsteps. Activation score was 54.7 ± 8.04 or 62.13% of maximum score. PAM scores differed significantly by age, education, income, and health status (P < .05). The items had good data quality fit statistics and good range of difficulty. The construct unidimensionality was confirmed by good model fits for Rasch model and principal component analysis of residuals found no meaning structure. The questionnaire showed acceptable psychometrics. Patient activation was moderate and needs to be improved.
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Affiliation(s)
- Subhranil Saha
- Clinical Research Unit (Homeopathy), Siliguri, under Central Council for Research in Homeopathy, India
| | - Munmun Koley
- Clinical Research Unit (Homeopathy), Siliguri, under Central Council for Research in Homeopathy, India
| | - E R Mahoney
- InsigniaHealth, One SW Columbia Street, Suite, Portland, Oregon
| | - Judith Hibbard
- Health Policy Research Group, University of Oregon, Eugene, USA
| | - Shubhamoy Ghosh
- Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Government of West Bengal, Howrah, India
| | - Goutam Nag
- Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Government of West Bengal, Howrah, India
| | - Rajib Purkait
- Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Government of West Bengal, Howrah, India
| | - Ramkumar Mondal
- Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Government of West Bengal, Howrah, India
| | | | - Supratim Patra
- Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Government of West Bengal, Howrah, India
| | - Seikh Swaif Ali
- Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Government of West Bengal, Howrah, India
| | - Jogendra Singh Arya
- Clinical Research Unit (Homeopathy), Siliguri, under Central Council for Research in Homeopathy, India
| | - Gurudev Choubey
- Clinical Research Unit (Homeopathy), Siliguri, under Central Council for Research in Homeopathy, India
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Saha S, Koley M, Ganguly S, Rath P, Chowdhury PR, Hossain SI. Developing the criteria for evaluating quality of individualization in homeopathic clinical trial reporting: a preliminary study. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2014; 12:13-9. [DOI: 10.1016/s2095-4964(14)60009-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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