2. Homeopaths claim that Shang dredged the data, which means that the meta‑analysis was conducted in such a way as to bias the conclusion.
There are indeed many ways to conduct a meta‑analysis. Therefore it is possible to ‘dredge the data’ in different ways until the most positive or negative result emerges, but importantly Shang had stated what his approach would be before embarking on the meta‑analysis, and his approach seemed reasonable and unbiased. In other words, the research was impartial because the goalposts were decided before the data was examined, and the goalposts were of a fair size and were not moved once the research was under way.
3. Homeopaths point out that the meta‑analysis included trials for several illnesses, which makes it too crude to say anything meaningful about homeopathy’s ability to treat individual conditions.
This over‑arching meta‑analysis was prompted by the fact that there has been no convincing evidence that homeopathy can treat any individual condition. Whenever researchers have conducted systematic reviews of homeopathy for a particular condition, the results have been consistently disappointing. For headaches and migraine: ‘The trial data available to date do not suggest that homeopathy is effective.’ For muscle soreness, the most tested condition: ‘The published evidence to date does not support the hypothesis that homoeopathic remedies used in these studies are more efficacious than placebo.’ For Arnica in the treatment of conditions associated with tissue trauma (e.g. post operative or post‑dental), which is the most widely used homeopathic remedy: ‘The claim that homeopathic Arnica is efficacious beyond placebo is not supported by rigorous clinical trials.’
4. Homeopaths point out that they offer a highly individualized treatment, which is not suited to large‑scale trials in which the homeopathic remedy is standardized.
Indeed, most trials have not been individualized, but there have been trials in which patients were given detailed consultations and either individualized homeopathic prescriptions or placebo. For example, an individualized trial monitoring ninety‑eight patients with chronic headaches over the course of twelve weeks led to the conclusion: ‘There was no significant difference in any parameter between homeopathy and placebo.’ Another trial focused on ninety‑six children with asthma and looked at their progress after twelve months of receiving individualized homeopathy or a placebo as an adjunct to their conventional treatment. It concluded: ‘This study provides no evidence that adjunctive homeopathic remedies, as prescribed by experienced homeopathic practitioners, are superior to placebo.’
Shang’s view of homeopathy is backed up by the Cochrane Collaboration, the highly respected, independent evaluator of medicines introduced in the previous chapter. There are Cochrane reviews on homeopathy for the induction of labour and the treatment of dementia, chronic asthma and flu. Cochrane’s conclusions are based on sixteen trials involving over 5,000 patients. Over and over again, the evidence is either non‑existent or shaky, leading to conclusions such as ‘there is not enough evidence to reliably assess the possible role of homeopathy in asthma’ ‘current evidence does not support a preventative effect’ and ‘there is insufficient evidence to recommend the use of homeopathy as a method of induction’.
It is interesting to contrast the tenor of these comments on homeopathy with Cochrane’s conclusion on a conventional medicine such as aspirin: ‘Aspirin is an effective analgesic for acute pain of moderate to severe intensity with a clear dose‑response.’ Moreover, Cochrane confirms how the efficacy of real medicine is so robust that it can be tested in different ways: ‘Type of pain model, pain measurement, sample size, quality of study design, and study duration had no significant impact on the results.’ This is the sort of confident conclusion that emerges when a genuinely effective medicine is tested. Sadly, research into homeopathy has failed to deliver any kind of positive conclusion.
Conclusions
It has taken several thousand words to review the history of homeopathy and to survey the various attempts to test its efficacy, but the conclusion is simple: hundreds of trials have failed to deliver significant or convincing evidence to support the use of homeopathy for the treatment of any particular ailment. On the contrary, it would be fair to say that there is a mountain of evidence to suggest that homeopathic remedies simply do not work. This should not be such a surprising conclusion when we recall that they typically do not contain a single molecule of any active ingredient.
This raises an interesting question: with no evidence that it works and with no reason why it ought to work, why is it that homeopathy has grown so rapidly over the last decade into a multi‑billion‑dollar global industry? Why do so many people think that homeopathy works, when the evidence, frankly, shows that it does not?
One problem is that the public are unaware of the vast body of research that undermines homeopathy. While Linde’s original overly optimistic paper from 1997 is hyped on many pro‑homeopathy websites, there are far fewer mentions of his more equivocal 1999 re‑analysis of exactly the same data. Similarly, the even more important and more negative 2005 paper by Shang is often omitted from homeopathy websites.
Worse still, the public can be misled by news stories that show homeopathy in an unjustifiably sympathetic light. One of the most high‑profile homeopathy news stories in recent years concerned a study by the Bristol Homoeopathic Hospital published in 2005. The hospital tracked 6,500 patients during a six‑year study and observed that 70 per cent of those suffering with chronic diseases reported positive health changes after homeopathic treatment. As far as the public was concerned, this appeared to be an extraordinarily positive result. However, the study had no control group, so it was impossible to determine whether these patients would have improved without any homeopathic treatment. The 70 per cent improvement rate could have been due to any number of factors, including natural healing processes, or patients being reluctant to disappoint whoever was interviewing them, or the placebo effect, or any other treatments that these patients may have been using. Science writer Timandra Harkness was one of many critics who tried to point out why the Bristol study was largely meaningless: ‘It’s as if you had a theory that feeding children nothing but cheese made them grow taller, so you fed all your children cheese, measured them after a year and said There–all of them have grown taller–proof that cheese works! ’
We suggest that you ignore the occasional media hype and instead rely on our conclusion, because it is based on examining all the reliable evidence–and the evidence suggests that homeopathy acts as nothing more than a placebo. For this reason, we strongly advise you to avoid homeopathic remedies if you are looking for a medicine that is more than just make‑believe.
Before ending this chapter, it is important to reiterate that we have come to our conclusions about homeopathy based on a fair, thorough, scientific assessment of the evidence. We have no axe to grind and have remained steadfastly open‑minded in our examination of homeopathy. Moreover, one of us has had a considerable amount of experience in homeopathy and has even spent time practising as a homeopath. After graduating from a conventional medical school, Professor Ernst then trained as a homeopath. He even practised at the homeopathic hospital in Munich, treating inpatients for a whole range of conditions. He recalls that the patients seemed to benefit, but at the time it was hard to determine whether this was due to homeopathy, the placebo effect, the dietary advice given by doctors, the body’s natural healing ability, or something else.