Biggest Homeopathy trial

[Undesired Walrus]

Have the Homeopaths ever done a proper medical trial for Homeopathy? 250 people taking placebo's against 250 people taking Homeopathic pills over the course of five years? It's not that difficult, and if they are already sure that their medicine is effective, they shouldn't be worried about such a trial that would show the positive effects of Homeopathy against the placebo. It would give it worldwide credibility in the scientific community.

[Mojo]

The problem with this is that it isn't really in their interest to conduct large high quality studies. See, for example, the findings of Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005 Aug 27-Sep 2;366(9487):726-32:

Quote:

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).

http://www.ncbi.nlm.nih.gov/pubmed/16125589

Larger trials tend not to show positive results for homoeopathy.

[Undesired Walrus]

How many people took part in that trial?

[Professor Yaffle]

Originally Posted by Undesired Walrus

How many people took part in that trial?

It was a meta analysis of all the placebo controlled trials.

[Mojo]

Originally Posted by Undesired Walrus

How many people took part in that trial?

It wasn't a single trial, it was a comparative analysis of 110 trials of homoeopathy and 110 matched trials of real medicine. Median study size was 65 participants, with a range of 10 to 1573.

You're too quick for me, Prof.

[Mojo]

It is particularly revealing that the trials that homoeopaths like to cite tend to be quite small. Even the most positive meta-analyses (i.e. the ones homoeopaths like to cite) make it clear that the quality of the reported trials tends to be problematic.

They do seem to be getting better at conducting trials though.

For example, a study published in Homeopathy (Mathie RT: The research evidence base for homeopathy: a fresh assessment of the literature. Homeopathy (2003) 92, 84–91) counted the trials between 1975 and the end of 2002 and found 50 positive, 41 inconclusive and 2 negative.

A document giving its source as the British Homeopathic Association (Mathie is their Research Development Adviser) says they found 119 trials up to the end of 2005. The percentages they give there work out to 58 positive, 57 inconclusive and 4 negative.

A document produced by the Faculty of Homeopathy (who are closely allied to the BHA) and published on the BHA's website, says "Up to the end of 2008, 138 RCTs had been published: 60 positive; 10 negative; 68 not statistically conclusive."

None of these appears to have taken any notice of study quality or size, indeed the Mathie (2003) paper explicitly states that it ignored study quality.

Assuming that all these figures have been arrived at on the same basis:

Up to 2002: 93 trials, 53.8% positive;
2003-2005: 26 trials, 30.8% positive;
2006-2008: 19 trials, 10.5% positive.

[Mojo]

The most positive review is probably Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997 Sep 20;350(9081):834-43, which concluded that "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." However, this conclusion was effectively retracted by a later paper by more or less the same authors, which reanalysed the same data with particular attention to the effects of study quality on bias, and concluded that:

Quote:

The evidence of bias weakens the findings of our original meta-analysis [7]. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new
high-quality trials (e.g. [14,15]) have negative results, and a recent update of our review for the most “original” subtype of homeopathy (classical or individualized homeopathy [16]), seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis [7] at least overestimated the effects of homeopathic treatments.

Source: Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB. Impact of study quality on outcome in placebo-controlled trials of homeopathy. J Clin Epidemiol. 1999 Jul;52(7):631-6.. Reference [7] is Linde et al. 1997.

For some reason homoeopaths love to cite the 1997 paper, but not the 1999 one.

Homoeopaths (and their apologists) often object that negative trials of homoeopathy are not proper tests of homoeopathy because they don't involve individualisation, and frequently claim that such trials are not possible, or have never been carried out, for example here in an article ironically titled "Your ignorance is showing". A review of trials of individualised homoeopathy was published about nine years before that article was written: Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state-of-the-art review. J Altern Complement Med. 1998 Winter;4(4):371-88 (reference [16] in the passage quoted above from Linde et al. 1999). Note the comment that the methodological quality of the trials was highly variable, and the conclusion that a small effect over all the available trials vanished when only the best quality trials were considered.

Another comment from that paper is perhaps relevant to the question in the OP:

Quote:

The motivation for doing trials seems less to be innovation or self-critical evaluation of performance (which is generally considered to be the motivation for good research) but rather justification in the face of a hostile scientific establishment.

[Dave Rogers]

Originally Posted by Mojo

Larger trials tend not to show positive results for homoeopathy.

In that case, shouldn't they argue that it would be a more effective trial if they compared the results on 10^-30 patients on homeopathic and 10^-30 on conventional medicine?

Dave