Homeopathy Benefit due to Placebo Effect
posted in - CAM watch, - Dobbs |From MedPageToday
Orthodox medicine is cutting no slack with homeopathy. A meta-analysis found that any benefits claimed by smaller and smaller doses of homeopathic medicine vanish into the never-never land of the placebo effect.
The meta-analysis of findings from 110 homeopathy trials and 110 matched conventional-medicine trials found that the benefits claimed by homeopathy can be explained by placebo effect, according to results reported in the Aug. 27 issue of The Lancet.
The researchers, led by Aijing Shang, Ph.D., of the University of Berne, said that previous reports that homoeopathic treatments were as effective as conventional or allopathic medicine were due to biases present in both homoeopathic and allopathic trials. But when the biases are stripped away, there is still strong evidence of benefit for conventional treatments but “there was no convincing evidence that homeopathy was superior to placebo.”
The Lancet Editorial goes on to comment that although it is unsurprising that homoeopathy fares poorly when compared with mainstream medicine, of greater interest is the fact that this debate continues, despite 150 years of unfavourable findings. The Lancet also reports that critics have slammed a draft WHO report on homoeopathy. The report apparently plays up research that supports homoeopathy while ignoring studies that cast doubt on its effectiveness. The report’s tone and approach are identical to a controversial 2003 report on acupuncture prepared by the same group.
The fact that there are so many quack alternatives and “miracle cures” in the market today shows that there is a demand for these products by an unsuspecting public. I think it is high time we start to caution patients about the use of alternative or non-conventional treatments that are not evidence-based if we have not been doing so.
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August 26th, 2005 at 3:25 pm
I am not saying this on behalf of homeopathic medicine, but in general, I see no wrong to prescribe for the placebo effect, so long as the side effect profile and cost are acceptable. We are there to make people FEEL better and sometimes that is necessary.
I have seen many prominent figures who presented in prestigious meetings criticising certain non-EBM practice, but when they themselves got caught in the situation where no drugs have been proven to be superior than placebo and the patients would not accept their advice of no intervention, they perscribed it for its placebo effect.
I think we have to take EBM with a pinch of salt, simply because the quality of evidence available is no where near the exalted place that we as a profession has raised EBM to.
August 26th, 2005 at 6:25 pm
Prescribing for placebo effect may compound the already serious problem of patients expecting something(anything!) for every niggle,ache or itch.
August 27th, 2005 at 1:19 am
I seldome use medication for placebo effect but what I was saying is that we should not under-setimate the beneficial effect of placebo effect and I believe there is still practical role for placebo effect in real life medicine. I am reluctant to see it being disregarded totally by EBM.
On the other hand, I am a big sceptic of meta-analysis. If there are good powered randomised control trials you don’t need meta-analysis. If there are insufficient big studies, personally I think it is wrong to group small studies which are usually heterogenous and pool the data together to prove something with p value
August 27th, 2005 at 1:30 am
less than 0.05. If you know how meta-analysis is being done, people have to decide whether to include this study or exclude that study, so a lot of bias involved.
August 27th, 2005 at 6:03 am
Sceptical or not, well conducted meta-analyses of RCTs are still Numero Uno – Level I in EBM.
Trouble with alternative medicine studies (if there are any at all) is that the numbers are small, and meta-analyses would give a better picture.
In this case, it would be more like Level II evidence
August 27th, 2005 at 4:03 pm
Poor quality meta-analysis is still regarded as Level 1 evidence, level 1b if you like. Hence there is a weakness in the current classification of EBM, and we are increasingly conscious of the fact that Level of evidence implies methodology not necessarily quality of evidence.
A well designed prospective controlled studies (Level 2) is better evidence than a poorly designed quasi-randomised studies (Level 1) with invalid outcomes measures. Likewise it is illogical to gather 10 poor heterogenous studies and analyse it Retrospectively and give the finding the highest level of evidence. When I read an article, the word meta-analysis or RCT does not mean anything to me anymore until I examine how they do it.
August 27th, 2005 at 4:18 pm
It’s just a statistical tool. The trouble with single prospective controlled studies are that you need the numbers – so if the trials are small it could be misleading as well. Meta-analyses are just a way to see the big picture. Of course there are limitations but a well designed meta-analysis may be better than a single small controlled study.
The main criticism about meta-analyses is not so much the meta-analysis itself – it’s the point that if the individual trials were rubbish in the first place, then the meta-analaysis would be also rubbish. So yes, one needs high quality individual trials and this in the “alternative medicine” world is sorely lacking.
August 27th, 2005 at 4:37 pm
Which is exactly my point, if the ‘alternative medicine’ science are rubbish, it is meaningless to meta-analyse them.
August 27th, 2005 at 4:44 pm
There have been good quality trials in the alternative medicine. Whether or not this Homeopathy meta-analysis is does a good job depends on the quality of the inidividual trials. I am not prepared to comment or criticise on this one specifically until I have actually read the whole paper and methodology.
August 18th, 2006 at 12:29 pm
Homoeopathic medicine is a wholistic approach to cure. Allopathic medicine is a specific approach to palliation. Cure at the causative level is never factored into the equation. Allopathic model of healing, if there is one, is based on the understanding of the physical and the biochemical. Biophysics which in recent years had shed quite a bit of light into how our body function and the progression of diseases in the body.
In homoeopathy if you have diarrhoea, the physician will go through tens, if not hundreds of other symptoms before recommending a remedy. An allopath will use an antipathic remedy i.e. one that will cause constipation.
Current understanding of drug profile on the body is that there is always a biphasic respond i.e. a cure of diarrhoea will cause constipation a little later on.
The narrow-minded way in which science look at the world leaves us blind to everything else. The double-blind requirement, the so-called gold standard of reliability is truly double blinding all those who revered it to other more profound and critical mechanism that life operates within. The concepts and prejudices in our head limits, defined and blind….we then go out and look for evidence of our narrow view of the world. Invariably we will find it. Life operates in a way that is far deeper and wider than any concept ; science or mathematics could ever hope to put together.
The search for remedy in homoeopathy is a refined art and as such the scientific model that is used study this healing art is inadequate. Until and unless a comprehensive model is built up to handle the wholistic nature of homoeopathy, the reductionistic approach will always be able to find a hole here and a hole there. But the hole that is seen came from an impaired vision.
Thus empirical data to affirm its efficacy takes on a more important role until we can have a better understanding of this phenomenon. In this regard the following historical event would prove instructive.
Consider the outbreak in london in 1831. Homoepaths achieved a motality rate of less than 4% while conventional medicine was 59%. In 1854 the homoeopathic hospital death rate was 16.4 % while the conventional medicine was 50% averaged out for other hospitals. Of course they did not have anti-biotics then but the point I’m making is that homoeopathic remedy does work even if it involves bugs. If anyone still claim placebo then it would really be a sad reflection on the quality of thinking of our doctors.
It was also instructive to note that when the homoeopathic hospitals wanted to include the statistics into the registry as was required by law during the outbreak the allopathic doctors refused to accept it, because it was not conventional medicine. When there was an uproar the data were collected and examined by allopathic doctors and later included into the registry.
One of the allopathic doctors who went round collecting the data were truly amazed at the result – not of the data – but of the CURE and rate of cure of actual patients he saw and audited. I have misplaced his quote…but if I find it again and if relevant I will post it.
Has allopathic medicine improved the odds in recent history ? Would really like to know if anyone has the data.
A good example of how allopathic medicine has failed society is the rate in which we suffer cancer, heart diseases and kidney failure these days. In 1900 the death from cancer was 1 in 8000. Now it is 1 in 3. It is well known in TCM and ayurveda that if you have pain in your joins it will lead to pain in the kidney and then to pain in the heart. And all these came from poor digestion. What does allopathic medicine at each of the manifestation of disease ? They kill the pain and as a result devitalises the person even more and set the stage for the next level of disease within the body. How can anyone in his right mind consider this as cure….but allopaths don’t talk of cure but palliation. Cut off the tonsils if it is giving problem…but you protest how about my immune system…not a problem we bave antibiotics. What kind of reasoning is this and what kind of healing model is this if all it does is to hammer down the symptoms. Look at the way in which kidney dialysis are being promoted and you will have an idea that allopaths basically have no idea what is happening. But cure , yes cure while it may seem empirical and not double blinded have been seen in numerous cases in tcm, ayurveda and homoeopathy very often after allopaths had packed up their bags.
The progression of diseases in these traditional cure is well known. A good physician in this field could tell you where your next sickness will come from…I’m not speaking out of school but actually had first-had experience when I was in india and visited an ayurvedic doctor and my view of allopaths from then on was forever transformed.
Some possible sites and books for expanding a bit of our understanding :
a. http://www.psicounsel.com/marius/research.html
b. http://www.phact.org/e/z/homeo.htm
c. “Confessions of a Medical Heretic” by Dr.Robert Mendelsohn, MD. From one of your own respected profession.
d. A mix-bag of energy medicine-
http://www.invitationtolife.org.au/research/welcome.htm
e. http://www.homoeopathica.org.nz/articlespf2.htm
f. This is very technical and very good http://www.homoeopathichouse.com/paulc.htm
If you have problem understanding the science you can email me. My background is in physics.
If we examine all these traditional healing art with a critical mind we must also use the same level of critical and skeptical mindset to examine allopathic medicine. I can assure you that if you put both of them side by side, allopaths look ugly indeed. And these had prompted Dr.Mahendralal Sirkar, the vice-president of the British Medical Association (Bengal Branch) to change his mind. He had denounced homoeopathy as quackery and yet he saw how easily Babu Rajendral Dutta, a lay practitioner without any high sounding titles were able to cure many diseases. He started looking into the homoeopathy and decided one day to give up his lucrative allopatic practice. The BMA imposed a boycott on him and in his reply he said, “Truth must be told, and truth must be acted upon.”
He became a towering giant of homoeopathy in India.
Hope this simple write up will help, if not all, at least a few to see beyond the narrow and harmful confine of allopathic medicine.
August 18th, 2006 at 12:49 pm
Treatment A or Hospital A may seemngly have less mortality than Treatment B or Hospital B because they saw milder cases.
The message we are trying to get across now is that because of the placebo effect and other things such as natural recovery, we need to show evidence in the form of Randomised Controlled Trials. So far homeopathy has not passed this test.
August 18th, 2006 at 11:13 pm
chiongguo,
Your description of how allopathic medicine (better-termed EBM because ‘Western’ medicine accepts and uses anything that has been PROVEN to work) works shows your poor understanding of EBM. We don’t go around giving anti-diarrhoeals for diarrhoea anymore. Previous decades ago we may have, along with blood-letting etc, but we take in new evidence and strive to improve constantly; unlike some other types of therapy. If diarrhoea is viral in origin let it run its course and maintain hydration, antibiotics for bacterial diarrhoea, removal of offending agent in food intolerance, and maybe antispasmodics of irritative lesions. The same applies for other conditions.
Cancer, diabetes, hypertension, heart and kidney diseases are increasing due to aging and lifestyle changes of the population. These are partially preventable in the early stages by lifestyle modifications which almost all doctors advocate. I don’t see how it is medicine’s fault thath people don’t follow the advice. May be we should charge more to appear more impressive?
Please look at the life expectancy in historical as well as geographical terms. If medicine is so bad, how come life expectancy has increased dramatically over the centuries in tandem with medical advances? How come TB DM pneumonia AGE etc changed from death sentences to high chance of cure? how come the regions with highest utilization of alternative therapy in place the EBM usually has the worst health indicators?
August 18th, 2006 at 11:18 pm
Please look historically : only 100 years ago people were dying in their thirties and forties from all sorts of infections and illnesses. Now people are often living to above 70, giving them the chance to develop all sorts of cancers etc.
So which one would you pick?
September 6th, 2006 at 10:09 pm
PalmDoc,
To claim that one side is seeing milder cases then the other would be speculating. You do not know and neither do I. Given the large number of cases in both epidemics and the large number of people seen by both sides it would be safe to say that severe cases are equally distributed in both sides.
If homeopathy is PURELY placebo wouldn’t the other hosipitals have equally stunning placebo effects ?
Huajern,
EBM is a misnomer. The Office of Technological Assessment of the US government had stated in their report that 95% of all drugs have not been proven to work. Tests are done on toxicity and NOT on effectiveness. (Healing zion, p.23).
How would you distinguish between viral, bacterial, food intolerance or food poisoning ? If you know it is viral will you still prescribe antibiotics ? Will you also not prescribe anti-diarrhoea drugs ?
Homoeopathy has 33 sub-symptoms to consider before a remedy is given.
Lifestyle is a major factor but what I’m suggesting and it is based on my own experiences that the “healing model” of EBM does not heal. It suppresses the symptoms until such time pathology occurs in the organs. Consider what my teacher says. He was a M.D from Grace Medical Mission but he’s a homoeopathic practitioner and teacher.
” A drug is said to be used allopathically when there is no direct relationship betweenthe physiological effects of drugs and the phe-nonema of the disease. This is made use of by the allopaths in. the treatment of ascitis by purgatives, of hydrothorax by diuretics, and of fever by diaphoretics or purgatives. Here, the bowels, the kidneys and the skin might have been normal in their functional activity, but they are stimulated increased action , in the hope of relieving the morbid condlitions present in some other parts of the system. This method is a round-about one, and it is uncertain in its actions. It may be of apparent success in some cases, and curative too at times. For instance, the occasional use of a purgative in cases of indisposition with headache and torpidity of the liver, is admittedly of a beneficient nature. Theconstant use of purcatives is, however deprecated. Such artificial stimulation of the bowels will weaken them afterwards, resulting in increased constipation and the attending evils or it may cause inflammations of the bowels with indigestion,diarrhoea etc. In the same manner, allopathic effects of drugs, like diuretics, diaphoretics etc; might cause injury to the healthy organs and the frequent and repeated administration of them sometimes even. poisons the whole system causing drug disease. So this method. of treatment, ought not to be adopted as a routine measure and should be ventured only on sufficient grounds.”
I believe EVM has no working model as to why cancer occurs and how certain traditional tribes (Hunza, red indains, eskimoes) do not suffer from cancer. Kidney failure is another mystery and so is heart failure. When the physician do not know how the failure occurs the physician will also not know of the harm that it will cause. Even till today how the aspirin works remain a mystery.
Some traditional tribes have life-span up to 120. The higher life expectancy cannot be attributed to modern medicine but inspite of it. The higher expectancy is a result of better sanitation, greater food supply, better education (yes this was one of the factors mentioned by WHO)etc.
The hospitals in the US are now the 3rd. largest killer. The data are taken only from states that need to report and DOES NOT include deaths due to physicians’ mistakes outside of the hospitals. If modern medicine kills more people than save (those on the verge of death and revived) then how could it take credit for prolonging life ? (I’m guessing here and I do not have figures to support it).
How about iatrogenic diseases ? WHO reported that 80% of all diseases are due to modern medicine.
TB, syphillis, influenza etc. could find cure or relief from homoeopathic remedies and the cure is ALWAYS very safe and has no side effects.
I would be very interested in finding out where you get the data that places that uses alternative(please don’t say it is voodoo) has worst health indicators then EBM ? I can quote you an indian goverment official report that says that homoeopathy in remote villages outperformed allopathy so much that the allopathic doctor has no business while the untrained homoeopathic doctor was kept busy most of the time.
You show me yours and I’ll show you mine
.
September 7th, 2006 at 1:15 am
The purpose of RCTs is to put paid to speculation.
“Office of Technological Assessment of the US government had stated in their report that 95% of all drugs have not been proven to work. Tests are done on toxicity and NOT on effectiveness.” is absolutely rubbish. I don’t know what era you are in but modern medicines and treatment for common illnesses nowadays e.g. for diabetes, hypertension, ischaemic heart disease, bacterial, viral, fungal infections and the vast numbers of chemotherapy regimens for various malignancies etc etc arecarried out on the basis of validated and published clinical trials which are not testing toxicity per se but clinical outcomes. Unless and until you have such evidence, then the treatment would be voodoo. Homeopathy, due to the lack of good quality positive clinical trials falls under this category. It’s as simple as that.
Tell you what if you have typhoid fever, tell me honestly would you go for conventional treatment or homeopathy? If you have a malignancy such as lymphoma or leukaemia would you go for homeopathy? If you choose the latter then all I can say is good luck to you. To subject infectious diseases such as TB and syphilis to homeopathy and not proper treatment would be in my books criminal. You are not only doing the patient disservice but would be creating public health havoc.
Kidney failure is not a mystery btw. And yes, we do know how aspirin works. Heart failure is not a disease but the result of various specific diseases. You are not an oncologist so I don’t expect you to know the tremendous advances we have in understanding the biology of cancer which is not one disease but comprises separate entities. For example modern science has unravelled the mechanism of Chronic Myeloid Leukaemia, the defect being the bcr-abl fusion gene which arises from a chromosomal translocation. Understanding of the molecular biology of this process has given rise to one of the most successful treatments for cancer today, the targetted drug Imatinib which blocks the tyrosine kinase product of the bcr-abl gene (and yes the results have been validated in large clinical trials). But being the believer in homeopathy that you are , and its obvious that you have this unshaken belief, should God forbid you ever have CML, I think you should go for Homeopathy instead since we can’t convince you otherwise.
May 27th, 2007 at 9:21 am
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