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Homeopathy 2010; 99(01): 76-82
DOI: 10.1016/j.homp.2009.11.002
 
Copyright © The Faculty of Homeopathy 2009

Placebo effect sizes in homeopathic compared to conventional drugs – a systematic review of randomised controlled trials

Tobias Nuhn
1   Klinik Roderbirken, Roderbirken 1, 42799 Leichlingen, Germany
,
Rainer Lüdtke
2   Karl und Veronica Carstens-Stiftung, Am Deimelsberg 36, 45276 Essen, Germany
,
Max Geraedts
3   Institut für Gesundheitssystemforschung, Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
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Publikationsverlauf

Received23. Juli 2009
revised20. Oktober 2009

accepted02. November 2009

Publikationsdatum:
20. Dezember 2017 (online)

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Background: It has been hypothesised that randomised, placebo-controlled clinical trials (RCTs) of classical (individualised) homeopathy often fail because placebo effects are substantially higher than in conventional medicine.

Objectives: To compare placebo effects in clinical trials on homeopathy to placebo effects on trials of conventional medicines.

Methods: We performed a systematic literature analysis on placebo-controlled double-blind RCTs on classical homeopathy. Each trial was matched to three placebo-controlled double-blind RCTs from conventional medicine (mainly pharmacological interventions) involving the same diagnosis. Matching criteria included severity of complaints, choice of outcome parameter, and treatment duration. Outcome was measured as the percentage change of symptom scores from baseline to end of treatment in the placebo group. 35 RCTs on classical homeopathy were identified. 10 were excluded because no relevant data could be extracted, or less than three matching conventional trials could be located.

Results: In 13 matched sets the placebo effect in the homeopathic trials was larger than the average placebo effect of the conventional trials, in 12 matched sets it was lower (P = 0.39). Additionally, no subgroup analysis yielded any significant difference.

Conclusions: Placebo effects in RCTs on classical homeopathy did not appear to be larger than placebo effects in conventional medicine.

Keywords

Homeopathy - Randomised placebo-controlled trials - Placebo effect - Systematic review
 

  • References

  • 1 Moerman D. Meaning, medicine and the ‘placebo effect’. Cambridge University Press; 2002.
    Google Scholar
  • 2 Starfield B., Wray C., Hess K. The influence of patient-practitioner agreement on outcome of care. Am J Public Health 1981; 71: 127-131.
    CrossrefPubMedGoogle Scholar
  • 3 Witt C.M., Lüdtke R., Baur R., Willich S.N. Homeopathic medical practice: long-term results of a cohort study with 3981 patients. BMC Public Health 2005; 5: 115.
    CrossrefPubMedGoogle Scholar
  • 4 Uexküll von T. “Psychosomatische Medizin” Modelle ärztlichen Denkens und Handelns. München, Jena: Urban&Fischer; 2003.
    Google Scholar
  • 5 Thompson E., Oxon B., Montgomery A., Douglas D., Reilly D. A Pilot, randomized, double-blinded, placebo-controlled trial of individualized homeopathy for symptoms of estrogen withdrawal in breast-cancer survivors. J Altern Complement Med 2005; 11: 13-20.
    CrossrefPubMedGoogle Scholar
  • 6 Eisenberg D.M., Davis R.B., Ettner S.L. et al. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. J Am Med Assoc 1998; 280: 1569-1575.
    CrossrefPubMedGoogle Scholar
  • 7 Thomas K., Coleman P. Use of complementary or alternative medicine in a general population in Great Britain. Results from the national omnibus survey. J Public Health (Oxf) 2004; 26: 152-157.
    CrossrefPubMedGoogle Scholar
  • 8 Thomas K.J., Nicholl J.P., Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complement Ther Med 2001; 9: 2-11.
    CrossrefPubMedGoogle Scholar
  • 9 Härtel U., Volger E. Inanspruchnahme und Akzeptanz klassischer Naturheilverfahren und alternativer Heilmethoden in Deutschland – Ergebnisse einer repräsentativen Bevölkerungsstudie. Forsch Komplementarmed Klass Naturheilkd 2004; 11: 327-334.
    CrossrefPubMedGoogle Scholar
  • 10 Haidinger G., Gredler B. Bekanntheitsgrad, Anwendungshäufigkeit und Erfolg alternativer Heilmethoden in Österreich – Ergebnisse einer Bevölkerungsbefragung. Offentl Gesundheitswes 1988; 50: 9-12.
    PubMedGoogle Scholar
  • 11 Hanssen B., Grimsgaard S., Launso L., Fonnebo V., Falkenberg T., Rasmussen N.K. Use of complementary and alternative medicine in the Scandinavian countries. Scand J Prim Health Care 2005; 23: 57-62.
    CrossrefPubMedGoogle Scholar
  • 12 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: 834-843.
    CrossrefPubMedGoogle Scholar
  • 13 Ernst E. Homeopathic prophylaxis of headaches and migraine? a systematic review. J Pain Symptom Manage 1999; 18: 353-357.
    CrossrefPubMedGoogle Scholar
  • 14 Jacobs J., Jonas W.B., Jimenez-Perez M., Crothers D. Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials. Pediatr Infect Dis J 2003; 22: 229-234.
    PubMedGoogle Scholar
  • 15 Lüdtke R., Hacke D. Zur Wirksamkeit des homöopathischen Arzneimittels Arnica montana. Wien Med Wochenschr 2005; 155: 482-490.
    CrossrefPubMedGoogle Scholar
  • 16 Lüdtke R., Rutten A.L. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J Clin Epidemiol 2008; 61: 1197-1204.
    CrossrefPubMedGoogle Scholar
  • 17 Shang A., Huwiler-Muntener 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: 726-732.
    CrossrefPubMedGoogle Scholar
  • 18 Walach H. Das Wirksamkeitsparadox in der Komplementärmedizin. Forsch Komplementarmed Klass Naturheilkd 2001; 8: 193-195.
    PubMedGoogle Scholar
  • 19 McDavid G.M. The homoeopathic treatment of acne [dissertation] . Durban, South Africa: Technikon Natal, 1994
    PubMedGoogle Scholar
  • 20 Jacobs J., Springer D.A., Crothers D. Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. Pediatr Infect Dis J 2001: 177-183.
    PubMedGoogle Scholar
  • 21 Siebenwirth J. A randomized, placebo controlled, double-blind study testing the effectiveness of classical homeopathic therapy of atopic dermitis (AD). In: Walach H. Future Directions and Current Issues of Research in Homeopathy. 2002. Freiburg.
    Google Scholar
  • 22 Jacobs J., Williams A., Girard C., Njike V., Katz D. Homeopathy for attention-deficit/hyperactivity disorder: a pilot randomised-controlled trial. J Altern Complement Med 2005; 11: 799-806.
    CrossrefPubMedGoogle Scholar
  • 23 Weatherley-Jones E., Nicholl J.P., Thomas K.J. et al. A randomised, controlled, triple-blind trial of the efficacy of homeopathic treatment for chronic fatigue syndrome. J Pschychosom Res 2004; 56 (02) 189-197.
    PubMedGoogle Scholar
  • 24 Jacobs J., Jiménez L.M., Malthouse S. et al. Homeopathic treatment of acute childhood diarrhea – results from a clinical trial in Nepal. J Altern Complement Med 2000; 6 (02) 131-139.
    CrossrefPubMedGoogle Scholar
  • 25 Jacobs J., Jiménez L.M., Gloyd S.S., Gale J.L., Crothers D. Treatment of acute childhood diarrhea with homoeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics 1994; 93 (05) 719-725.
    PubMedGoogle Scholar
  • 26 Jacobs J., Jiminez L.M., Gloyd S., Carares F.E., Gaitan M.P., Crothers D. Homoeopathic treatment of acute childhood diarrhoea – a randomized clinical trial in Nicaragua. Br Homeopath J 1993; 82 (02) 83-86.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 27 Bonne O., Shemer Y., Gorali Y., Katz M., Shalev A.Y. A randomized, double-blind, placebo-controlled study of classical homeopathy in generalized anxiety disorder. J Clin Psychopharmacol 2003; 64 (03) 282-287.
    PubMedGoogle Scholar
  • 28 Carlini E.A., Braz S., Landfranco R.P. Efeito hipnótico de medicacão homeopática e do placebo – Avaliacão pela técnica de “duplo-cego” e “cruzamento”. Rev Assoc Med Bras 1987; 33: 83-88.
    PubMedGoogle Scholar
  • 29 Straumsheim P., Borchgevink C., Mowinckel P., Kierulf H., Hafslund O. Homeopathic treatment of migraine: a double blind, placebo controlled trial of 68 patients. Br Homeopath J 2000; 89: 4-7.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 30 Walach H., Haeusler W., Lowes T. et al. Classical homeopathic treatment of chronic headaches. Cephalalgia 1997; 17: 119-126.
    CrossrefPubMedGoogle Scholar
  • 31 Whitmarsh T., Coleston-Shields D.M., Steiner T.J. Double-blind randomised placebo-controlled study of homoeopathic prophylaxis of migraine. Cephalalgia 1997; 17: 600-604.
    CrossrefPubMedGoogle Scholar
  • 32 Brigo B., Serpelloni G. Homoeopathic treatment of migraines – a double-blind controlled study of sixty cases (Homoeopathic Remedy versus Placebo). Berlin J Res Hom 1991; 1 (02) 98-106.
    PubMedGoogle Scholar
  • 33 Brigo B: Le traitement homéopathique de la migraine – Une étude de 60 cas contrôlée en double aveugle – Remède homéopathique vs Placebo. In 42nd Congress of LMHI. 1987.
    PubMed
  • 34 Jacobs J., Herman P., Heron K., Olsen S., Vaughters L. Homeopathy for menopausal symptoms in breast cancer survivors: a preliminary randomized controlled trial. J Altern Complement Med 2005; 11: 21-27.
    CrossrefPubMedGoogle Scholar
  • 35 Chapman E.H., Angelica J., Spitalny G., Strauss M. Results of a study of the homoeopathic treatment of PMS. J Am Inst Homeopath 1994; 87: 14-21.
    PubMedGoogle Scholar
  • 36 Yakir M, Kreitler S, Oberbaum M, Bzizinsky A, Vithoulkas G, Bentwich Z: Homoeopathic treatment of premenstrual syndrome – a pilot study. In 8th GIRI Meeting. Jerusalem, Israel, 1994.
    PubMed
  • 37 Yakir M., Kreitler S., Brzezinski A., Vithoulkas G., Oberbaum M., Bentwich Z. Effects of homeopathic treatment in women with premenstrual syndrome – a pilot study. Brit Hom J 2001; 90 (03) 148-153.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 38 de Lange-de-Klerk E.S.M., Blommers J., Kuik D.J., Bezemer P.D., Feenstra L. Effects of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections. BMJ 1994; 309: 1329-1332.
    CrossrefPubMedGoogle Scholar
  • 39 Fisher P., Scott D.L. A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology 2001; 40: 1052-1055.
    CrossrefPubMedGoogle Scholar
  • 40 Gibson R.G., Gibson S.L.M., MacNeill A.D., Buchanan W.W. Homoeopathic therapy in rheumatoid arthritis – evaluation by double-blind clinical therapeutic trial. Br J Clin Pharmacol 1980; 9: 453-459.
    CrossrefPubMedGoogle Scholar
  • 41 Andrade L.E.C., Ferraz M.B., Atra E., Castro A., Silva M.S.M. A randomized controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis. Scand J Rheumatol 1991; 20: 204-208.
    CrossrefPubMedGoogle Scholar
  • 42 Kainz J.T., Kozel G., Haidvogl M., Smolle J. Homoeopathic versus placebo therapy of children with warts on the hands – a randomized, double-blind clinical trial. J Dermatol 1996; 193: 318-320.
    CrossrefPubMedGoogle Scholar
  • 43 Lökken P., Straumsheim P.A., Tveiten D., Skjelbred P., Borchgrevink C.F. Effect of homoeopathy on pain and other events after acute trauma: placebo controlled trial with bilateral oral surgery. BMJ 1995; 310: 1439-1442.
    CrossrefPubMedGoogle Scholar
  • 44 Kuzeff R.M. Homeopathy, sensation of well-being and CD4-levels – a placebo-controlled, randomized trial. Complement Ther Med 1998; 6 (01) 4-9.
    CrossrefPubMedGoogle Scholar
  • 45 Diener H.C., Kronfeld K., Boewing G. et al. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol 2006; 5: 310-316.
    CrossrefPubMedGoogle Scholar
  • 46 Scharf H.P., Mansmann U., Streitberger K. et al. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Ann Intern Med 2006; 145: 12-20.
    CrossrefPubMedGoogle Scholar
  • 47 Haake M., Muller H.H., Schade-Brittinger C. et al. German acupuncture trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med 2007; 167: 1892-1898.
    CrossrefPubMedGoogle Scholar
  • 48 Steinsbekk A., Bentzen N., Fonnebo V., Lewith G. Self treatment with one of three self selected, ultramolecular homeopathic medicines for the prevention of upper respiratory tract infections in children. A double-blind randomized placebo controlled trial. Br J Clin Pharmacol 2005; 59: 447-455.
    CrossrefPubMedGoogle Scholar
  • 49 Steinsbekk A., Lewith G., Fonnebo V., Bentzen N. An exploratory study of the contextual effect of homeopathic care. A randomised controlled trial of homeopathic care vs. self-prescribed homeopathic medicine in the prevention of upper respiratory tract infections in children. Prev Med 2007; 45: 274-279 discussion 280–271.
    CrossrefPubMedGoogle Scholar
  • 50 Steinsbekk A., Fonnebo V., Lewith G., Bentzen N. Homeopathic care for the prevention of upper respiratory tract infections in children: a pragmatic, randomised, controlled trial comparing individualised homeopathic care and waiting-list controls. Complement Ther Med 2005; 13: 231-238.
    CrossrefPubMedGoogle Scholar
  • 51 Fisher P., McCarney R., Hasford C., Vickers A. Evaluation of specific and non-specific effects in homeopathy: feasibility study for a randomised trial. Homeopathy 2006; 95: 215-222.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 52 Cho H.J., Hotopf M., Wessely S. The placebo response in the treatment of chronic fatigue syndrome: a systematic review and meta-analysis. Psychosom Med 2005; 67: 301-313.
    CrossrefPubMedGoogle Scholar
  • 53 Macedo A., Banos J.E., Farre M. Placebo response in the prophylaxis of migraine: a meta-analysis. Eur J Pain 2008; 12: 68-75.
    CrossrefPubMedGoogle Scholar
  • 54 Rutten A.L., Stolper C.F. The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy 2008; 97: 169-177.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 55 Linde K. Der spezifische placeboeffekt. Bundesgesundheitsblatt 2006; 49: 729-735.
    PubMedGoogle Scholar
  • 56 Milgrom L. Are randomized controlled trials (RCTs) redundant for testing the efficacy of homeopathy? A critique of RCT methodology based on entanglement theory. J Altern Complement Med 2005; 11: 831-838.
    CrossrefPubMedGoogle Scholar