El Arte De La Guerra

Eur J Clin Pharmacol (2000) 56: 27±33

Ó Springer-Verlag 2000

SPECIAL ARTICLE

M. Cucherat á M. C. Haugh á M. Gooch J.-P. Boissel, for the HMRAG group

Evidence of clinical ef®cacy of homeopathy
A meta-analysis of clinical trials

Received: 19 August 1999 / Accepted in revised form: 29 December 1999

Abstract Objective: To establish, using a systematic review and meta-analysis,whether there is any evidence from randomised controlled clinical trials of the ecacy of homeopathic treatment in patients with any disease. Data sources: Published and unpublished reports of controlled clinical trials available up to June 1998, identi®ed by searching bibliographic databases (Medline, Embase, Biosis, PsychInfo, Cinahl, British Library Stock Alert Service, SIGLE, Amed), referenceslists of selected papers, hand searching homeopathic journals and conference abstracts, and contacting pharmaceutical companies. Trials selection: Trials were selected using an unblinded process by two reviewers. The selection criteria were randomised, controlled trials in which the ecacy of homeopathic treatment was assessed relative to placebo in patients using clinical or surrogate endpoints.Prevention trials or those evaluating only biological e€ects were excluded. One hundred and eighteen randomised trials were identi®ed and evaluated for inclusion. Sixteen trials, representing 17 comparisons and including a total of 2617 evaluated patients, ful®lled the inclusion criteria. Data extraction: Data were extracted by two reviewers independently, using a summary form. Disagreements wereresolved by a third person. Data synthesis: The evidence was synthesised by combining the signi®cance levels (P values) for the primary outcomes from the individual trials. The combined P value for the 17 comparisons was highly signi®cant

P ˆ 0.000036. However, sensitivity analysis showed that the P value tended towards a non-signi®cant value (P ˆ 0.08) as trials were excluded in a stepwise mannerbased on their level of quality. Conclusions: There is some evidence that homeopathic treatments are more e€ective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies. Further high quality studies are needed to con®rm these results.Key words Homeopathy á Meta-analysis á Randomised clinical trial

Introduction
Although homeopathic treatments have been commonly used for many decades, their ecacy is still controversial. No scienti®c explanation for the mechanism of action of homeopathy is currently universally accepted, despite wide and often controversial debate [1±5]. One question that is often asked is a very broad one:is homeopathy ecacious? This question may seem too general, but it is in these terms that the problem is often posed. The aim of our study was to determine, using a systematic review and meta-analysis, whether there is any evidence from randomised controlled trials that homeopathy is ecacious for the treatment of disease in humans. An unbiased conclusion is of utmost importance in this domainbecause it is a scienti®c, emotional and political issue in many areas of the world. Given that the question asked in this meta-analysis is broad, we examined evidence from all trials in which a homeopathic treatment was compared with placebo, irrespective of the nature of the treatment and the disease treated. This project was undertaken as one component of a report prepared for the EuropeanParliament by the Brussels Commission.

M. Cucherat (&) á M. C. Haugh á J.-P. Boissel Department of Clinical Pharmacology, Hospitals of Lyon and University Claude Bernard, Â Faculte RTH Laennec, BP 8071, F-69376 Lyon, France e-mail: mcu@upcl.univ-lyonl.fr Tel.: +33-478-785757; Fax: +33-478-776917 M. Gooch Academic Departments, Glasgow Homeopathic Hospital, Glasgow, Scotland, UK

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Materials...