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Homeopathy: systematic review of systematic reviews

Systematic review
Results
Comment

Bandolier once got a bit hot under the collar about a meta-analysis of homeopathy that concluded that it worked. The problem was that trials were small, there were 24 clinical categories, four types of homeopathy, and 50 classes of homeopathic remedy. Low quality trials were included. The authors themselves concluded that 'we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition'. A systematic review of systematic reviews agrees with that conclusion [1].

Systematic review

Extensive literature searches, including specialist databases, was for systematic reviews of homeopathic treatments. Only systematic reviews of controlled trials were used.

Results

There were six re-analyses of the original meta-analysis. These showed that more rigorous study design was associated with less effect, making the overall effect insignificant.

A further 11 systematic reviews published between 1997 and 2001 were located. They were carried out in different conditions with different homeopathic remedies. Conditions included postoperative ileus, delayed onset muscle soreness, migraine, influenza, asthma, rheumatic conditions and osteoarthritis. The number of patients for each condition was as small as 150 and as large as 3,400.

None of these systematic reviews provided any convincing evidence that homeopathy was effective for any condition. The lesson was often that the best designed trials had the most negative result, as reported in Bandolier 46.

Comment

We should not be surprised. Even ardent proponents of homeopathy who have performed a critical overview conclude that homeopathy 'should not be substituted for proven therapies' [2].

Much of the argument about homeopathy ends up being about trivial differences of little or no clinical relevance. Until large and well conducted randomised trials tell us differently, the conclusion is that homeopathy does not work, and its use instead of remedies of proven effectiveness is not a matter of trivial implication. Members of the public are relieved of much money each year by homeopaths. There's little evidence they are relieved of any suffering.

Reference:

  1. E Ernst. A systematic review of systematic reviews of homeopathy. British Journal of Clinical Pharmacology 2002 54: 577-582.
  2. WB Jonas et al. A critical overview of homeopathy. Annals of Internal Medicine 2003 138: 393-399.

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