- Email: [email protected]
Are the clinical effects of homoeopathy placebo effects? – Authors' reply
Correspondence
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Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834–43. Sterne JAC, Gavaghan DJ, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol 2000; 53: 1119–29. McNamee D, Horton R. Lies, damn lies, and reports of RCTs. Lancet 1996; 348: 562. Kjaergard LL, Villumsen J, Gluud C. Reported methodological quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001; 135: 982–89. Juni P, Nartey L, Reichenbach S, Sterchi R, Dieppe PA, Egger M. Risk of cardiovascular events and rofecoxib: cumulative meta-analysis. Lancet 2004; 364: 2021–29.
The article on homoeopathy by Aijing Shang and colleagues1 attracted much attention in India. Prominent placement of this item in national newspapers2,3 shows the importance homoeopathy occupies in this country. The news of its “end” was shocking for thousands over their morning cup of tea. Homoeopathy is one of the most popular systems of medicine here. Many generations have systematically followed homoeopathic treatment. Many strictly observe the instructions of physicians, but thousands in our country do not trust allopathy. Their view is that it gives quick relief, but that it acts like a slow poison on the organs. Our late Prime Minister, Morarji Desai, reputedly never took drugs or injections. Homoeopathy is taught at the graduate and postgraduate level. Established departments have been doing research on various drugs, or on several aspects of the system, with encouraging results. The reaction to the paper published by Shang and colleagues was swift. Many regarded their findings as a challenge to homoeopathic physicians to do more research work. The highest government authority, Uma Pillai, secretary of the department of Ayurveda, homoeopathy, and yoga posed the question: how could a single study dismiss an entire system?
A government report projected that homoeopathy has been practiced in 66 countries, where millions have benefited and over-the-counter sales have grown from US$25 million in 1999 to $32 million in 2004. It also pointed out that the market for alternative medicine had grown 45% over 5 years. Its acceptability was shown by the fact that homoeopathic medicines are prescribed by allopathic general practitioners. The role of WHO in popularising homoeopathy was also remembered. Shang and colleagues’ research report on homoeopathy will not affect the growth of the system in our country. Many people believe that the increased popularity of homoeopathy has financially harmed the allopathy system, and that reports such as that of Shang and colleagues are calculated attempts to counter it. In all probability, this article will be treated with great cynicism. We declare that we have no conflict of interest.
*K P Skandhan, S Amith, S Avni [email protected] Department of Physiology, Sri Devaraj Urs Medical College, Kolar 563101, India 1
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Shang A, Huwiler-Müntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366: 726–32. Lall RR. Homoeopathy just dummy drug. The Times of India Aug 27, 2005: 1. Bosley S. Some questions about homoeopathy: a fourth study says it is no better than placebo. The Hindu Aug 27, 2005: 24.
For homoeopathy, there are two main areas of concern: there is the question of its efficacy and there is the continued debate about its usefulness. Aijing Shang and colleagues1 revisit the findings of various placebo-controlled trials comparing the efficacies of homoeopathy and allopathy. In the end, Shang and colleagues lend further credence to the notion that the clinical effects of homoeopathy are placebo effects. Their findings seem convincing. However, this does not resolve the problem of treating patients. In my opinion, it does not make any sense
www.thelancet.com Vol 366 December 17/24/31, 2005
to oppose an efficient homoeopathic treatment prescribed for well defined indications. Then, there is also the question of the relative efficacy of homoeopathic versus allopathic treatment for such common and often trivial ailments as bronchitis or common cold. Although not recommended, antibiotics and cortisone are widely prescribed for common cold and bronchitis, especially in France. I launched my medical career in the 1970s, and it was not an uncommon medical practice throughout that decade and the early part of the next to treat pregnancy-induced anaemia with blood transfusions and childhood infections with immunoglobulins. It needs no reiteration that many of those who received such treatments are now carriers of hepatitis C. These patients might have benefited from homoeopathy. It is doubtful that anyone would ever prescribe a compound with widely known placebo effects. Would any physician tell his patient he was prescribing something that, although not effective, might work? A compound is unlikely to act as a placebo when the recipient knows that its only effects are as such. I have been pursuing scientific activities for nearly three decades. I do not believe that there is anything active in homoeopathic pills. However, I feel that we have not yet assessed the potential usefulness of homoeopathic medication in the context of inappropriately prescribed allopathic medications or receipt of no medication at all. In such settings, the cost-effectiveness of homoeopathic therapy should be compared with that of allopathic medication. The age-old dictum Primum non nocere still holds true. From this viewpoint, homoeopathy should be assessed as a possible competitor to allopathy. I declare that I have no conflict of interest.
Rights were not granted to include this image in electronic media. Please refer to the printed journal
Didier Raoult
Still Pictures
Department of Social and Preventive Medicine, University of Berne, Berne, Switzerland (AS, PJ, KH-M, ME); and MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, UK (JACS, ME)
[email protected]
2085
1
2
3 4
5
Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834–43. Sterne JAC, Gavaghan DJ, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol 2000; 53: 1119–29. McNamee D, Horton R. Lies, damn lies, and reports of RCTs. Lancet 1996; 348: 562. Kjaergard LL, Villumsen J, Gluud C. Reported methodological quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001; 135: 982–89. Juni P, Nartey L, Reichenbach S, Sterchi R, Dieppe PA, Egger M. Risk of cardiovascular events and rofecoxib: cumulative meta-analysis. Lancet 2004; 364: 2021–29.
The article on homoeopathy by Aijing Shang and colleagues1 attracted much attention in India. Prominent placement of this item in national newspapers2,3 shows the importance homoeopathy occupies in this country. The news of its “end” was shocking for thousands over their morning cup of tea. Homoeopathy is one of the most popular systems of medicine here. Many generations have systematically followed homoeopathic treatment. Many strictly observe the instructions of physicians, but thousands in our country do not trust allopathy. Their view is that it gives quick relief, but that it acts like a slow poison on the organs. Our late Prime Minister, Morarji Desai, reputedly never took drugs or injections. Homoeopathy is taught at the graduate and postgraduate level. Established departments have been doing research on various drugs, or on several aspects of the system, with encouraging results. The reaction to the paper published by Shang and colleagues was swift. Many regarded their findings as a challenge to homoeopathic physicians to do more research work. The highest government authority, Uma Pillai, secretary of the department of Ayurveda, homoeopathy, and yoga posed the question: how could a single study dismiss an entire system?
A government report projected that homoeopathy has been practiced in 66 countries, where millions have benefited and over-the-counter sales have grown from US$25 million in 1999 to $32 million in 2004. It also pointed out that the market for alternative medicine had grown 45% over 5 years. Its acceptability was shown by the fact that homoeopathic medicines are prescribed by allopathic general practitioners. The role of WHO in popularising homoeopathy was also remembered. Shang and colleagues’ research report on homoeopathy will not affect the growth of the system in our country. Many people believe that the increased popularity of homoeopathy has financially harmed the allopathy system, and that reports such as that of Shang and colleagues are calculated attempts to counter it. In all probability, this article will be treated with great cynicism. We declare that we have no conflict of interest.
*K P Skandhan, S Amith, S Avni [email protected] Department of Physiology, Sri Devaraj Urs Medical College, Kolar 563101, India 1
2 3
Shang A, Huwiler-Müntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366: 726–32. Lall RR. Homoeopathy just dummy drug. The Times of India Aug 27, 2005: 1. Bosley S. Some questions about homoeopathy: a fourth study says it is no better than placebo. The Hindu Aug 27, 2005: 24.
For homoeopathy, there are two main areas of concern: there is the question of its efficacy and there is the continued debate about its usefulness. Aijing Shang and colleagues1 revisit the findings of various placebo-controlled trials comparing the efficacies of homoeopathy and allopathy. In the end, Shang and colleagues lend further credence to the notion that the clinical effects of homoeopathy are placebo effects. Their findings seem convincing. However, this does not resolve the problem of treating patients. In my opinion, it does not make any sense
www.thelancet.com Vol 366 December 17/24/31, 2005
to oppose an efficient homoeopathic treatment prescribed for well defined indications. Then, there is also the question of the relative efficacy of homoeopathic versus allopathic treatment for such common and often trivial ailments as bronchitis or common cold. Although not recommended, antibiotics and cortisone are widely prescribed for common cold and bronchitis, especially in France. I launched my medical career in the 1970s, and it was not an uncommon medical practice throughout that decade and the early part of the next to treat pregnancy-induced anaemia with blood transfusions and childhood infections with immunoglobulins. It needs no reiteration that many of those who received such treatments are now carriers of hepatitis C. These patients might have benefited from homoeopathy. It is doubtful that anyone would ever prescribe a compound with widely known placebo effects. Would any physician tell his patient he was prescribing something that, although not effective, might work? A compound is unlikely to act as a placebo when the recipient knows that its only effects are as such. I have been pursuing scientific activities for nearly three decades. I do not believe that there is anything active in homoeopathic pills. However, I feel that we have not yet assessed the potential usefulness of homoeopathic medication in the context of inappropriately prescribed allopathic medications or receipt of no medication at all. In such settings, the cost-effectiveness of homoeopathic therapy should be compared with that of allopathic medication. The age-old dictum Primum non nocere still holds true. From this viewpoint, homoeopathy should be assessed as a possible competitor to allopathy. I declare that I have no conflict of interest.
Rights were not granted to include this image in electronic media. Please refer to the printed journal
Didier Raoult
Still Pictures
Department of Social and Preventive Medicine, University of Berne, Berne, Switzerland (AS, PJ, KH-M, ME); and MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, UK (JACS, ME)
[email protected]
2085