Integrative Care
Policy News

Research Conference Oasis in “Homeopathic Desert”

12 December, 2013 by David Finer

Homeopathic IC´s reporters are not easily daunted. Recently, we reported from the European Sceptics Conference in Stockholm. This time, we have attended the First Nordic Homeopathy Research Conference, held in Gothenburg, Sweden. All with the aim of giving our readers hot news from the frontiers of CAM research and debate. Following on Dr. Peter Fisher´s characterization of Sweden as a “homeopathic desert”, the meeting was a revitalizing oasis, at least for the already converted.

The conference was held at the distinguished Nordic School of Public Health (NHV) in Gothenburg. Having followed the academic progress of the School for a number of years, I found myself wondering what the staff would have thought.

After all, in the eyes of many beholders, homeopathy has come to represent the epitome of pseudoscience.  Practitioners and researchers of homeopathy were now invading its time-honored halls, once part of a naval base.

Supportive Research Policy
But then I was reminded of the research policy, adopted by the School in 2003. According to the policy, the mission is to bridge gaps, involve various professions, work in an interdisciplinary manner, combine medical, social and other approaches, and finally, work within various research paradigms and with various methods. So it seemed like the homeopaths were in the right place after all!

Some 150 participants, researchers, students, practitioners of homeopathy and integrative medicine as well as allopathic researchers and practitioners and finally, a handful of journalists attended the conference. The invited speakers came from Norway, Scotland and the UK.

Overview on Effects
Dr. Peter Fisher, clinical head and research head, the Royal London Hospital for Integrated Medicine, London, England gave an overview over research on effects of homeopathy. Dr. Fisher is an accredited specialist in homeopathy and a rheumatologist, as well as being a member of WHO´s expert council on traditional and complementary medicine, Editor of the journal Homeopathy and physician to the British royal family.

Fisher began by thanking for the invitation and expressing how pleased he was that the conference had been organized in Sweden, traditionally “somewhat of a homeopathic desert”.

Criticized Meta-Analysis
He focused on a critique of the Lancet 2005 Shang et al meta-analysis, highlighting two main issues: Do homeopathic medicines have positive effects separate from placebo effects? Is homeopathy effective/cost-effective?

The meta-analysis was based on 110 matched trials of homeopathy and conventional medicine identified in the scientific literature. Through exclusion, the number was reduced to only include high quality studies, of which 21 were homeopathic and 14 conventional. Further exclusion yielded 8 studies of homeopathy and 6 of conventional medicine.

Both types of studies suffered from the distorting effects of bias, Fisher said. In both cases, smaller trials of lower quality displayed more positive treatment effects than larger studies of higher quality.

Disturbing Conclusion
In summary, according to Shang, the selected studied showed weak evidence for specific effects of homeopathic remedies but strong evidence for specific effects of conventional measures. The findings were interpreted as being in line with a view of the effect of homeopathy as purely placebo.

Fisher described the conclusion as disturbing for several reasons, one being that statistical analysis of so called funnel plots of the studies showed almost exactly the same values for the results of the homeopathic as for those of the conventional studies.

Originally, complete details of the included studies were lacking, but when they all had been revealed, it was also clear that the conclusions were not as definitive as previously reported, said Fisher. The results of the Shang study were tenuous and relied heavily on a certain study and a particular indication.

Fisher found it more remarkable still that the 8 mentioned homeopathic studies were anonymized, making it impossible for other researchers to identify and study them, and that 93 percent of the studies found in the scientific literature had been excluded.

No Sensitivity Analysis
Other sources of error in the Shang analysis were – according to Fisher – that studies were included post-hoc and that no sensitivity analysis was performed.

This criticism is on the line with that in the paper by Lüdtke and Rutten in Journal of Clinical Epidemiology in 2008, which looked at the Shang meta-analysis and concluded that “the results change sensitively to the chosen threshold defining large sample sizes. Because of the high heterogeneity between the trials, Shang’s results and conclusions are less definite than had been presented.”

More Positive Results
Previous meta-analyses  – by Kleijnen and collaborators in British Medical Journal 1991 and by Linde and collaborators in the Lancet 1997 – showed more positive results in homeopathy´s favour. In contrast to Shang, Linde´s account was completely transparent, Fisher said.

According to Kleijnen, 81/105 studies, which could be interpreted, were positive. The authors wrote that if only the active mechanism for homeopathy were more credible, there would probably be cause to establish homeopathy as common practice for treating certain conditions.

According to Linde 1997, 89/186 studies could be interpreted. The results were not compatible with the hypothesis that the effects of homeopathy were due to placebo. But neither did the meta-analysis show any clear effects in any single condition.

In 2013, Mathie and collaborators published a review of randomized controlled studies in the journal Homeopathy. The conclusion is that previous accounts of the literature have been unsatisfactory. The review includes i.a. 30 studies, which Mathie and collaborators conclude have been missed by Linde and Shang, respectively.

Meet Criterion of Model Validity
In conclusion, Fisher said the results of systematic reviews and meta-analyses displayed controversial but mainly positive results for homeopathy in certain conditions or groups of conditions. As for the results of single RCTs, the results are mixed.

Many of them do not allow for solid conclusions, but few studies are negative. However, many of these RCTs meet the criterion of so called model validity.  Model validity reflects the concordance between the trial study design and “state of the art” practice for the intervention under investigation. It should, however, be added, that in terms of homeopathy, the reference to model validity would hardly convince staunch representatives of allopathic medicine.

The situation for homeopathy in the UK is difficult, Peter Fisher said in the discussion. The sceptics attack homeopathy angrily and claim that is lacks evidence. That is wrong, Fisher said. Moreover, homeopathy enjoys strong support in Parliament.

Aggravation or Side Effect
Trine Stub, Department of Community Medicine, National Research Center in Complementary and Alternative Medicine (NAFKAM), University of Tromsø, Norway reported on a study previously published by her, Anita Salamonsen and Terje Alraek with the title ”Is It Possible to Distinguish Homeopathic Aggravation from Adverse Effects? A Qualitative Study”. The aim of the study was to identify criteria for doing that.

Homeopathic aggravation is a temporary worsening of existing symptoms following the administration of a correct homeopathic prescription and is usually followed by an improvement . It indicates that the individual is responding to the medication by generating or increasing symptoms, which is seen as the body’s way of coping with illness and as part of the healing process.

According to homeopathic literature, the duration of aggravation depends on when the symptoms have started, the degree to which they have previously been suppressed or blocked, and the overall vitality or ability of an individual to heal. In a true aggravation, the patients will often give some indication of feeling better, either emotionally, mentally or generally, often with an increase in energy or improved sleep.

A qualitative approach was employed, interviewing 11 experienced homeopaths who had practiced classical homeopathy for 10–32 years. Eight criteria that distinguish aggravation from adverse effect were found. The criteria found may ensure patient safety and support therapists in identifying an ‘undesirable effect of a remedy’.

Unclear Cost-Effectiveness
Peter Viksveen, University of Sheffield presented a similarly published evaluation of the cost-effectiveness of homeopathy. First, some 868 studies were identified, of which 481 were excluded. Finally, 15 relevant articles remained, reporting on 14 economic evaluations of homeopathy. Thirteen studies reported numbers of patients: a total of 3500 patients received homeopathic treatment and 10 studies reported on control group participants.

Eight out of 14 studies found improvements in patients’ health together with cost savings. Four studies found that improvements in homeopathy patients were at least as good as in control group patients, at comparable costs. Two studies found improvements similar to conventional treatment, but at higher costs.

Peter Viksveen concluded that although the identified evidence of the costs and potential benefits of homeopathy seemed promising, studies were highly heterogeneous and had several methodological weaknesses. It is therefore not possible to draw firm conclusions on cost-effectiveness based on existing economic evaluations of homeopathy.

David Finer


Hahn R. Homeopathy: Meta-Analyses of Pooled Clinical Data. Forsch Komplementmed 2013;20:376–381.

Lüdtke R, Rutten AL.   The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials.  J Clin Epidemiol. 2008 Dec; 61(12):1197-204. doi: 10.1016/j.jclinepi.2008.06.015. Epub 2008 Oct 1.

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.

Stub T, Salamonsen A, Alraek T. Is It Possible to Distinguish Homeopathic Aggravation from Adverse Effects? A Qualitative Study. Forsch Komplementmed 2012;19:13–19.



Tags: , , , , , , , , , , , , , , , , , ,

Comments are closed.