Meta Analysis and Systematic Reviews

Meta Analyses, Cochrane Review, Randomised Controlled Trial

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Abstract

Upto the end of year 2011, there have been 11 meta-analysis (1 on in vitro study, 1 on combination remedy) published in 10 medical journals (7 integrative, 1 homeopathy and 2 CAM journals). Out of 11 meta analysis, 5 are comprehensive/global, 5 on specific medical condition and 1 on super-avogadro dilution effect. Upto the end of year 2010, there have been 8 systematic reviews (1 on combination remedy) including 1 cochrane review (out of approximately 20 systematic reviews published) published in 5 medical journals (1 integrative, 1 homeopathy and 3 CAM journals) in evidence of homeopathy.

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URL Links to 19 studies (Journal-wise) including 11 FULL TEXT papers are available as compendium on this webpage. 5 meta analysis and 6 systematic reviews are also available as PDF which can be read at or downloaded from Google Drive.

The compendium is prepared by mining 14 online electronic databases: PubMed Central (National Library of medicine, USA),MedWorm,British library Direct (type homeopathy in search box), Centre for Reviews and Dissemination (type homeopathy in search box), Scirus,Google Scholarand HomBRexThe Allied and Complementary Medicine Database,Cochrane Central Register of Controlled Trial, Excerpta Medica Database Embase,Science Citation Index,LilacsandCAM QUESTand Clinical Outcome Research in Homeopathy (http://www.carstens-stiftung.de/core-hom/login.php)

E

xclusion Criterion (What kind of studies are not included?)

1. Studies on Plants and Animals

2.Studies published in non-journal paper

3.Non-peer reviewed studies from year 1893 onwards

4.Statistically non-significant studies (Probability value<0.05, odds ratio >1, indicates statistical significance)

5.Studies in which combination of homeopathic medicine with any other medicine is prescribed

6.Studies in which medicine is perceived to be homeopathic but is not such as radionically prepared or different potencies of same medicine mixed together


Bias: Bias is a systematic error i.e. the difference between study findings/outcomes and the truth.

Publication Bias: The tendency for studies with a positive result to be published more readily than those which are negative or inconclusive.

Meta Analysis of RCT: It is a statistical method of combining results from multiple randomised controlled trials for different indications in the form of a weighted average (some studies carries more weight than others) to determine overall trend or significance as an output. It helps in reducing information overload, find publication bias, if any and may explain heterogeneity between the results of individual studies.

The first meta analysis on typhoid inoculation was published in British Medical Journal in 1904. The first meta analysis of a medical treatment was published in 1955. The first meta analysis in evidence of homeopathy was published in 1991.

Systematic Review: It is synthesis of the results of several studies (including conflicting studies) so as to assess the strength of the evidence.A review is termed systematic if it is based on clearly formulated peer-reviewed protocols (in advance) such as research question, clear inclusion/exclusion criterion, explicit search strategy, critical appraisal, etc and employs the same level of scientific rigour as should be used to produce that research evidence in the first place. A systematic review is as good as the quality of studies included in the review. A systematic review can be independently replicated. The first systematic review in evidence of homeopathy was published in 2000.

Systematic reviews often, but not always, use statistical techniques such as meta-analysis to combine results of the eligible studies. The purpose of both meta analysis and systematic review is to obtain a better understanding of how treatment works.

META ANALYSIS

META ANALYSIS (COMPREHENSIVE)

1. British Medical Journal

Clinical Trials of Homeopathy (1991) FULL TEXT // 81 (77%) out of 105 RCT (1943-1990) shows statistically significant result for homeopathy and 15 out of 22 best quality studies are also statistically significant.

Out of 81, 5 out of 5 of the clinical trials for hay fever showed a positive result and 8 out of 10 trials looking at mental or emotional problems showed a beneficial effect, while 6 out of 7 trials for infection showed that homeopathy could effectively relieve the problem.

“Based on this evidence we would be ready to accept that homoeopathy can be efficacious, if only the mechanism of action were more plausible” and “the evidence presented in this review would probably be sufficient for establishing homoeopathy as a regular treatment for certain indications……..a conventional method would have been acknowledged with this amount of evidence”, the results are mostly favourable for homeopathy regarding the quality of trials.”

2. The Lancet

Are clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trialsLinde et.al. (1997) FULL TEXT // AMSTAR score=9/11, 74 out of 89 RCT (1966-1995) showed homeopathy statistically significantly superior [2.45 times more effective and positive at 95% confidence interval (CI)] to placebo. After correction for publication bias, the odds ratio reduces to 1.78, still statistically significant. 26 out of 89 studies were of high quality for which odds ratio reduces further to 1.66, still significant.In 1999, the authors reassessed the studies and found that 10 trials with highest jaded score (Jaded 5) still significant.

The main conclusion was that the results “were not compatible with the hypothesis that the effects of homoeopathy are completely due to placebo.”

3. The Journal of Alternative and Complementary Medicine

Randomized controlled trials of individualized homeopathy: a state-of-the-art (1998) // AMSTAR score =8/11, Out of 32 RCT for 19 clinical conditions, overall odd ratio for high quality 19 trials =1.62 (statistically significant) at 95% CI which reduces to 1.12 (not statistically significant) for 6 best quality trials at 95% CI.

4. European Journal of Clinical Pharmacology

Evidence of clinical efficacy of homeopathy (2000) // AMSTAR score =10/11, 11 (65%) out of 17 comparisons in 16 RCT (1967-1998) for 15 clinical condition shows statistically significant results, p= 0.000036. For 16 double-blind RCT, p=0.000068. For 9 randomised double-blind studies, p=0.0084. For 5 high quality double-blind RCT, p=0.082.Significant effect of homeopathy (p=0.048) in the duration of diarrhoea. Significant effect of homeopathy over placebo in influenza (p=0.0257)

5. Homeopathy

The 2005 meta-analysis of homeopathy: the importance of post-publication data (2008) FULL TEXT

META ANALYSIS ON SPECIFIC MEDICAL CONDITION

1. Journal of Clinical Gastroenterology

Homeopathy forpost-operative ileus: meta analysis (1997) //AMSTAR score=6/11, Barnes, E. Ernst, 6 trials, 776 patients, medicines: Opium, Arnica, Raphanus sativus, China, Pyrogenum, 4 out of 6 trials are of best quality. Two of the four studies that also measured time to first faeces reported a positive effect for homeopathy. A meta-analysis of all six included studies revealed a statistically significant effect in favour of homeopathy for time to first flatus (weighted mean difference (WMD) -7.4; 95% CI -4.0 to -10.8; p<0.05). This effect remained even with the exclusion of the two low quality studies (WMD -6.11; 95% CI -2.31 to -9.91; p<0.005). A significant effect in favour of homeopathy was also found for time to first flatus when a homeopathic remedy of less than 12C potency was used (4 studies; WMD -6.6; 95% CI -2.6 to -10.5; p<0.05). Conclusion: “there is some evidence to support the administration of a homeopathic remedy immediately after surgery to reduce the duration of ileus”

2.Wiener Medizinische Wochenschrift

Homeopathic Galphimia glauca for hay fever(1997) //Galpimia Glauca in 2c, 4c, 4x, 6x, LM4. N=1038, The odds ratios of all of the four individual studies favoured homeopathy, and in two of the four studies the result was statistically significant. After the results were pooled, the odds ratio of 1.87 suggested that Galphimia glauca is significantly more effective than placebo.

The same study was published in 1997 in Journal ‘

Wiener Medizinische Wochenschrift’

3. British Medical Journal

Homeopathy for allergic rhinitis: meta analysis (2000) FULL TEXT // 4 DBRPCT (2 on hayfever, 1 on asthma and 1 on perennial rhinitis) with n=253, p=0.0007, mixed pollen 30c for hayfever

4. Paediatric Infectious Disease Journal

Homeopathy for diarrhea: meta-analysis (2003) ) FULL TEXT //n=242, age=6 months to 5 years, t=5 days, p=0.008, A meta-analysis of three studies showing individualized homeopathy reduced the duration of the disease by a quarter. Diarrhoea ceased in those taking homeopathic medicines after 3.3 days and after 4.1 days in those using placebo.

5. Arzneimittel-Forschung(German) meaning ‘Medicines Research’

Treatment of vertigo with vertigoheel (2005) // combination remedy

META ANALYSIS ON HIGH DILUTIONS

1. Human and Experiment Toxicology

Meta-analysis of serial agitated dilutions in experimental toxicology (1994) // 80% homeopathic medicines shows efficacy

SYSTEMATIC REVIEWS

1.Rheumatic Diseases Clinics of North America

Homeopathy and Rheumatic Diseases (2000)// 6 controlled trials (3 in Rheumatoid Arthritis with n=226, 1 osteoarthritis, 1 fibromyalgia) with n=392, odds ratio= 2.19 at 95% CI, for high quality trials OR=2.11, still significant (p=0.002)

2. British Homeopathic Journal

Homeopathic remedies for the treatment of osteoarthritis: a systematic review (2001) (by Long and Ernst) // 4 RCT with n=506,Zeel superior to hyaluronic acid, combination of Rhus Tox, Causticum and Lac Vac superior to paracetamol.AMSTAR score=6/10, homeopathy found to be “at least as effective” as a conventional NSAID gel, “positive trend towards the effectiveness of combination homeopathic preparations”.

3.Forschende Komplementarmedizin(German) meaning ‘Research in Complimentary Medicine’

Effectiveness, Safety and Cost-Effectiveness of Homeopathy in General Practice (2006) FULL TEXT

4. Evidence based Complementary and Alternative Medicine

Immunolgy and Homeopathy-4 PART-1 (2006) FULL TEXT

Immunolgy and Homeopathy-4 PART-2 (2006) FULL TEXT

5. Complementary Therapies in Medicine

The in vitro evidence for an effect of high homeopathic potencies—A systematic review (2007) FULL TEXT // 73% of 67 in-vitro experiments (1/3 of them replicated) published in 75 publications showed specific effects with high dilutions including 68% of high quality experiments (SAPEH score>=6).Nearly 3/4 of them found a high potency effect. Nearly 3/4 of all replications were positive.

6. Homeopathy

Placebo effect size in placebo-controlled clinical trials of individualised homeopathy are same as that of conventional trials(2010) FULL TEXT

COCHRANE DATABASE OF SYSTEMATIC REVIEW

Homeopathic medicines for adverse effects of cancer treatments (2009) FULL TEXT // 8 RCT (7 placebo-controlled and 1 against active intervention)with n=664,2 trials in support of homeopathy

Homeopathic medicines for the prevention or treatment of adverse effects of chemotherapy, radiotherapy, and menopausal symptoms caused by hormonal therapies or oestrogen withdrawal.

Compared with trolamine, calendula reduced the incidence of acute dermatitis of grade two or above in women undergoing radiotherapy for breast cancer in one clinical trial involving 254 participants.

Based on a single trial involving 32 participants, Traumeel S appears to show promise in the treatment of chemotherapy-induced stomatitis.

FURTHER READING: Scientific research in Homeopathy

Last Modified: This webpage was last updated on 02 March 2015.

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6 Comments

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  1. Dr. Nancy Malik

  2. debbybruck

    Very nice compendium of clinical trials that were published in medical journals. Of course, many thousands more trials were conducted, but not published to add to this database. Your article was unbiased and clear, just posting the reports without commentary, allowing readers to come to their own conclusions. Thank you, Nancy.

  3. Jayney

    Thank you Nancy – this is most helpful.

    • Dr. Nancy Malik

      Thank You Jayney. Regards

  4. Dr. Nancy Malik

    49% of systematic reviews on conventional medicine reach ‘inconclusive’ conclusions and 96% recommend further research.
    Ref: El Dib, R.P., Atallah, A. N. & Andriolo, R. B. Mapping the Cochrane evidence for decision making in health care. Journal of Evaluation in Clinical Practice. 13, pp.689–692 (2007).

  5. Dr. Nancy Malik

    Following weblink are updated
    1. BMJ (1991) “Clinical Trials of Homeopathy” meta-analysis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1668980/pdf/bmj00112-0022.pdf
    2. Lancet (1997) “Are clinical effects of homeopathy placebo effects?” http://bit.ly/VYi6nX

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