The research evidence base for homeopathy: a fresh assessment of the literature

Abstract

Background.  The claims made for the clinical effects of homeopathy are controversial. The results of several meta-analyses of clinical trials are positive, but they fail in general to highlight specific medical conditions that respond well to homeopathy.

Aims.  This review examines the cumulative research from randomised and/or double-blind clinical trials (RCTs) in homeopathy for individual medical conditions reported since 1975, and asks the question: What is the weight of the original evidence from published RCTs that homeopathy has an effect that is statistically significantly different from that in a comparative group?

Method.  Analysis of the 93 substantive RCTs that compare homeopathy either with placebo or another treatment.

Results.  50 papers report a significant benefit of homeopathy in at least one clinical outcome measure, 41 that fail to discern any inter-group differences, and two that describe an inferior response with homeopathy. Considering the relative number of research articles on the 35 different medical conditions in which such research has been carried out, the weight of evidence currently favours a positive treatment effect in eight: childhood diarrhoea, fibrositis, hayfever, influenza, pain (miscellaneous), side-effects of radio- or chemotherapy, sprains and upper respiratory tract infection. Based on published research to date, it seems unlikely that homeopathy is efficacious for headache, stroke or warts. Insufficient research prevents conclusions from being drawn about any other medical conditions.

Conclusions.  The available research evidence emphasises the need for much more and better-directed research in homeopathy. A fresh agenda of enquiry should consider beyond (but include) the placebo-controlled trial. Each study should adopt research methods and outcome measurements linked to a question addressing the clinical significance of homeopathy's effects.

Keywords

homeopathy - research design - evidence-based medicine - clinical trials

Publication History

Received: 19 November 2002

Accepted: 06 January 2003

Article published online:
16 September 2021

• References

• 1 Mathie RT. Clinical outcomes research: contributions to the evidence base for homeopathy. Homeopathy 2003; 92: 56-57
• 2 Paterson J. Report on the mustard gas experiments (Glasgow and London). Br Hom J 1943; 33: 1-12
• 3 Ritter H. Ein homöotherapeutischer doppelter Blindversuch und seine Problematik. Hippokrates 1966; 12: 472-476
• 4 Kennedy CO. A controlled trial. Br Hom J 1971; 60: 120-127
• 5 Ustianowski PA. A clinical trial of Staphysagria in postcoital cystitis. Br Hom J 1974; 63: 276-277
• 6 Linde K, Clausius N, Ramirez G. et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834-843
• 7 NHS Centre for Reviews and Dissemination. Homeopathy. Effective Health Care Bulletin 2002; 7 (03) 1-12
• 8 Harrison H, Fixsen A, Vickers A. A randomized comparison of homoeopathic and standard care for the treatment of glue ear in children. Complement Ther Med 1999; 7: 132-135
• 9 van Haselen RA, Fisher PAG. A randomized controlled trial comparing topical piroxicam gel with a homeopathic gel in osteoarthritis of the knee. Rheumatology 2000; 39: 714-719
• 10 Gmünder R, Kissling R. The efficacy of homeopathy in the treatment of chronic low back pain compared to standardized physiotherapy. Z Orthop Ihre Grenzgeb 2002; 140: 503-508
• 11 Fisher P, Scott DL. A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology 2001; 40: 1052-1055
• 12 Kaziro GS. Metronidazole (Flagyl) and Arnica montana in the prevention of post-surgical complications, a comparative placebo controlled clinical trial. Br J Oral Maxillofac Surg 1984; 22: 42-49
• 13 Reilly D. Randomised controlled trials for homoeopathy: when is useful improvement a waste of time? Double positive paradox of negative trials. Br Med J 2002; 325: 42
• 14 Gassinger CA, Wunstel G, Netter P. A controlled clinical trial for testing the efficacy of the homeopathic drug Eupatorium perfoliatum D2 in the treatment of common cold. Arzneimittelforschung 1981; 31: 732-736
• 15 Maiwald VL, Weinfurtner T, Mau J, Connert WD. Therapy of common cold with a homeopathic combination preparation in comparison with acetylsalicylic acid. A controlled, randomized double-blind study. Arzneimittelforschung 1988; 38: 578-582
• 16 Lüdtke R, Wiesenauer M. A meta-analysis of homeopathic treatment of pollinosis with Galphimia glauca. Wien Med Wochenschr 1997; 147: 323-327
• 17 Barnes J, Resch K-L, Ernst E. Homeopathy for postoperative ileus? A meta-analysis. J Clin Gastroenterol 1997; 25: 628-633
• 18 Jonas WB, Linde K, Ramirez G. Homeopathy and rheumatic disease. Rheum Dis Clin North Am 2000; 26: 117-123
• 19 Linde K, Jobst KA. Homeopathy for chronic asthma. Cochrane Database Syst Rev 2000; 2: CD000353
• 20 Vickers AJ, Smith C. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndrome. Cochrane Database Syst Rev 2000; 2: CD001957
• 21 Ernst E, Barnes J. Are homoeopathic remedies effective for delayed-onset muscle soreness? A systematic review of placebo-controlled trials. Perfusion (Nürnberg) 1998; 11: 4-8
• 22 Long L, Ernst E. Homeopathic remedies for the treatment of osteoarthritis: a systematic review. Br Hom J 2001; 90: 37-43
• 23 Ernst E. Homeopathic prophylaxis of headaches and migraine? A systematic review. J Pain Symptom Manage 1999; 18: 353-357
• 24 Ernst E, Pittler MH. Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials. Arch Surg 1998; 133: 1187-1190
• 25 Cucherat M, Haugh MC, Gooch M. Boissel J-P. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. Eur J Clin Pharmacol 2000; 56: 27-33
• 26 Kleijnen J, Knipschild P. ter Riet G. Clinical trials of homeopathy. Br Med J 1991; 302: 316-23
• 27 Sterne JAC, Egger M. Davey Smith G. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. Br Med J 2001; 323: 101-105
• 28 Jacobs J, Springer DA, Crothers D. Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. Pediatr Infect Dis J 2001; 20: 177-183
• 29 Ernst E. A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol 2002; 54: 577-582
• 30 Rieberer G. Who's that talking?. Homeopathy 2002; 91: 106-108
• 31 Jones B, Jarvis P, Lewis JA, Ebbutt AF. Trials to assess equivalence: the importance of rigorous methods. Br Med J 1996; 313: 36-39
• 32 Matusiewicz R. The effect of a homeopathic preparation on the clinical condition of patients with corticosteroid-dependent bronchial asthma. Biomed Ther 1997; 15: 70-74
• 33 Reilly D, Taylor MA, Beattie NGM. et al. Is evidence for homoeopathy reproducible?. Lancet 1994; 344: 1601-1606
• 34 Freitas L, Goldenstein E, Sanna OM. A relação médico-paciente indireta e o tratamento homeopáatíco na asma infantile. Rev Homeopatia 1995; 60: 26-31
• 35 Lewith G, Watkins AD, Hyland ME. et al. Use of ultramolecular potencies of allergen to treat asthmatic people allergic to house dust mite: double blind randomised controlled clinical trial. Br Med J 2002; 324: 520-523
• 36 Reilly DT, Taylor MA. Potent placebo or potency? A proposed study model with initial findings using homoeopathically prepared pollens in hayfever. Br Hom J 1985; 74: 65-75
• 37 Reilly DT, Taylor MA, McSharry C, Aitchison T. Is homoeopathy a placebo response? Controlled trial of homoeopathic potency, with pollen in hayfever as model. Lancet 1986; ii: 881-886
• 38 Taylor MA, Reilly D, Llewellyn-Jones RH. et al. Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. Br Med J 2000; 321: 471-476
• 39 Wiesenauer M, Häussler S, Gaus W. Pollinosis therapy with Galphimia glauca. Fortschr Med 1983; 101: 811-814
• 40 Wiesenauer M, Gaus W, Häussler S. Behandlung der Pollinosis mit Galphimia glauca: Eine Doppelblindstudie unter Praxisbedingungen. Allergologie 1990; 13: 359-363
• 41 Wiesenauer M, Lüdtke R. The treatment of pollinosis with Galphimia glauca D4’a randomized placebo-controlled double-blind clinical trial. Phytomedicine 1995; 2: 3-6
• 42 Aabel S. Prophylactic and acute treatment with the homeopathic medicine Betula 30c for birch pollen allergy: a double-blind, randomized, placebo-controlled study of consistency of VAS responses. Br Hom J 2001; 90: 73-78
• 43 Wiesenauer M, Gaus W. Double-blind trial comparing the effectiveness of the homeopathic preparation Galphimia potentiation D6, Galphimia dilution 10⁻⁶ and placebo on pollinosis. Arzneimittelforschung 1985; 35: 1745-1747
• 44 Weiser M, Gegenheimer LH, Klein P. A randomized equivalence trial comparing the efficacy and safety of Luffa comp.-Heel nasal spray with cromolyn sodium spray in the treatment of seasonal allergic rhinitis. Forsch Komplementarmed 1999; 6: 142-148
• 45 Bignamini M, Bertoli A, Consolandi AM. et al. Controlled double-blind trial with Baryta carbonica 15 CH versus placebo in a group of hypertensive subjects confined to bed in two old people's homes. Br Hom J 1987; 76: 114-119
• 46 Hitzenberger G, Korn A, Dorcsi M. et al. Controlled randomized double-blind study for the comparison of the treatment of patients with essential hypertension with homeopathic and with pharmacologically effective drugs. Wien Klin Wochenschr 1982; 94: 665-670
• 47 Hill N, Stam C, Tuinder S. van Haselen RA. A placebo controlled clinical trial investigating the efficacy of a homeopathic after-bite gel in reducing mosquito bite induced erythema. Eur J Clin Pharmacol 1995; 49: 103-108
• 48 Hill N, Stam C. van Haselen RA. The efficacy of Prrrikweg gel in the treatment of insect bites: a double-blind, placebo-controlled clinical trial. Pharm World Sci 1996; 18: 35-41
• 49 Garrett B, Harrison PV, Stewart T, Porter I. A trial of homoeopathic treatment of leg ulcers. J Dermatol Treatment 1997; 8: 115-117
• 50 Smith SA, Baker AE, Williams JH. Effective treatment of seborrheic dermatitis using a low dose, oral homeopathic medication consisting of potassium bromide, sodium bromide, nickel sulfate, and sodium chloride in a double-blind, placebo-controlled study. Altern Med Rev 2002; 7: 59-67
• 51 Kainz JT, Kozel G, Haidvogl M, Smolle J. Homoeopathic versus placebo therapy of children with warts on the hands: a randomized, double-blind clinical trial. Dermatology 1996; 193: 318-320
• 52 Labrecque M, Audet D, Latulippe LG, Drouin J. Homeopathic treatment of plantar warts. Can Med Assoc J 1992; 146: 1749-1753
• 53 Ferley JP, Zmirou D, Adhemar D, Balducci F. A controlled evaluation of a homoeopathic preparation in the treatment of influenza-like syndromes. Br J Clin Pharmacol 1989; 27: 329-335
• 54 Papp R, Schuback G, Beck E. et al. Oscillococcinum in patients with influenza-like syndromes: a placebo-controlled double-blind evaluation. Br Hom J 1998; 87: 69-76
• 55 de Lange de Klerk ES, Blommers J, Kuik DJ. et al. Effect of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections. Br Med J 1994; 309: 1329-1332
• 56 Mössinger P. Untersuchung zur Behandlung des akuten Fliessschnupfens mit Euphorbium D3. Allg Homöopath Ztg 1982; 227: 89-95
• 57 Lecoq PL. Les voies therapeutiques des syndromes grippaux. Cahiers Biothérap 1985; 87: 65-73
• 58 Mössinger P. Untersuchung über die Behandlung des akuten Pharyngitis mit Phytolacca D2. Allg Homöopath Ztg 1976; 221: 177-83
• 59 Weiser M. Clasen BPE. Controlled double-blind study of a homeopathic sinusitis medication. Biol Ther 1995; 13: 4-11
• 60 Bordes LR, Dorfman P. Evaluation de l'activité antitussive du sirop Drosetux: étude en double aveugle versus placebo. Cahiers d’O R L 1986; 21: 731-734
• 61 Diefenbach M, Schilken J, Steiner G, Becker HJ. Homeopathic therapy in respiratory tract diseases. Evaluation of a clinical study in 258 patients. Zeitschr für Allgemeinmedizin 1997; 73: 308-314
• 62 Wiesenauer M, Gaus W, Bohnacker U, Häussler S. Efficiency of homeopathic preparation combinations in sinusitis. Results of a randomized double blind study with general practitioners. Arzneimittelforschung 1989; 39: 620-625
• 63 Jacobs J, Jiminez LM, Gloyd S. et al. Homoeopathic treatment of acute childhood diarrhoea: a randomized clinical trial in Nicaragua. Br Hom J 1993; 82: 83-86
• 64 Jacobs J, Jiminez LM, Gloyd SS. et al. Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics 1994; 93: 719-725
• 65 Jacobs J, Jimenez LM, Malthouse S. et al. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. J Altern Complement Med 2000; 6: 131-139
• 66 Rahlfs VW, Mössinger P. Asa foetida in the treatment of the irritable colon: a double-blind trial. Dtsch Med Wochenschr 1979; 104: 140-143
• 67 Rahlfs VW, Mössinger P. Treatment of irritable colon. A multicenter placebo-controlled double-blind study in general practice. Arzneimittelforschung 1976; 26: 2230-2234
• 68 Aulagnier G. Action d’un traitement homéopathique sur la reprise du transit post opératoire. Homéopathie 1985; 6: 42-45
• 69 Dorfman P, Amodéo C, Ricciotti F. et al. Iléus post-opératoire et homéopathie: bilan d'une évaluation clinique. Cahiers Biothérap 1992; 114: 33-39
• 70 Groupe de Recherches et d'Essais Cliniques en Homéopathie. Evaluation of two homeopathic products on the resumption of transit after digestive surgery. A multicentre controlled trial. Presse Med 1989; 18: 59-62
• 71 Gerhard I, Monga B, Roebruck P, Runnebaum B. Homoeopathy versus conventional therapy in female infertility: Interim analysis of a randomized study. Forsch Komplementarmed 1997; 5: 262-269
• 72 Beer AM, Sturm R, Kupper F. Der Einsatz eines homöopathischen Syndrom im Vergleich zur Hormonsubstitution. Erfahrungsheilkunde 1995; 44: 336-340
• 73 Yakir M, Kreitler S, Brzezinski A. et al. Effects of homeopathic treatment in women with premenstrual syndrome: a pilot study. Br Hom J 2001; 90: 148-153
• 74 Chapman EH, Angelica J, Spitalny G, Strauss M. Results of a study of the homeopathic treatment of PMS. J Am Inst Homeopath 1994; 87: 14-21
• 75 Hofmeyr GJ, Piccioni V, Blauhof P. Postpartum homoeopathic Arnica montana: a potency-finding pilot study. Br J Clin Pract 1990; 44: 619-621
• 76 Fisher P. An experimental double-blind clinical trial method in homoeopathy. Use of a limited range of remedies to treat fibrositis. Br Hom J 1986; 75: 142-147
• 77 Fisher P, Greenwood A, Huskisson EC. et al. Effect of homeopathic treatment on fibrositis (primary fibromyalgia). Br Med J 1989; 299: 365-366
• 78 Tveiten D, Bruseth S, Borchgrevink CF, Norseth J. Effects of the homoeopathic remedy Arnica D30 on marathon runners: a randomized, double-blind study during the 1995 Oslo Marathon. Complement Ther Med 1998; 6: 71-74
• 79 Hariveau E. La recherche clinique a l'institut Boiron. Homéopathie 1987; 5: 55-58
• 80 Schmidt C. A double-blind, placebo-controlled trial: Arnica montana applied topically to subcutaneous mechanical injuries. J Am Inst Homeopath 1996; 89: 186-193
• 81 Jawara N, Lewith G, Mullee M. et al. Homoeopathic Arnica and Rhus Toxicodendron for delayed onset muscle soreness: a randomised, double-blind, placebo-controlled trial. Br Hom J 1997; 86: 10-15
• 82 Vickers AJ, Fisher P, Smith C. et al. Homeopathic Arnica 30x is ineffective for muscle soreness after long-distance running: a randomized, double-blind, placebo-controlled trial. Clin J Pain 1998; 14: 227-231
• 83 Shipley M, Berry H, Broster G. et al. Controlled trial of homoeopathic treatment of osteoarthritis. Lancet 1983; i: 97-98
• 84 Nahler G, Metelmann H, Sperber H. Treating osteoarthritis of the knee with a homeopathic preparation: results of a randomized, controlled, clinical trial in comparison to hyaluronic acid. Biomed Ther 1998; 16: 186-191
• 85 Shealey CN, Thomlinson RP, Cox RH, Borgmeyer V. Osteoarthritic pain: a comparison of homeopathy and acetaminophen. Am J Pain Manage 1998; 8: 89-91
• 86 Gibson RG, Gibson SL, MacNeill AD, Buchanan WW. Homoeopathic therapy in rheumatoid arthritis: evaluation by double-blind clinical therapeutic trial. Br J Clin Pharmacol 1980; 9: 453-459
• 87 Wiesenauer M, Gaus W. Wirksamkeitsnachweis eines Homöopathikums bei chronischer Polyarthritis. Eine randomisierte Doppelblindstudie bei niedergelassenen Ärzten. Akt Rheumatol 1991; 16: 1-9
• 88 Köhler T. Wirksamkeitnachweis eines Homöopathikums bei chronischer Polyarthritis - eine randomisierte Doppelblindstudie bei niedergelassenen Ärzten. Der Kassenarzt 1991; 13: 48-52
• 89 Andrade LE, Ferraz MB, Atra E. et al. A randomized controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis. Scand J Rheumatol 1991; 20: 204-208
• 90 Böhmer D, Ambrus P. Behandlung von Sportverletzungen mit Traumeel-Salbe’Kontrollierte Doppelblindstudie. Biol Med 1992; 21: 260-268
• 91 Zell J, Connert WD, Mau J, Feuerstake G. Treatment of acute sprains of the ankle joint. Double-blind study assessing the effectiveness of a homeopathic ointment preparation. Fortschr Med 1988; 106: 96-100
• 92 McCutcheon LE. Treatment of anxiety with a homeopathic remedy. J Appl Nutr 1996; 48: 2-6
• 93 Lamont J. Homoeopathic treatment of attention deficit hyperactivity disorder. A controlled study. Br Hom J 1997; 86: 196-200
• 94 Gaus W. Biometrische Aspekte der “Munchener Kopfschmerzstudie” Allgem. Homöopath Zeit 1997; 242: 245-249
• 95 Walach H, Haeusler W, Lowes T. et al. Classical homeopathic treatment of chronic headaches. Cephalalgia 1997; 17: 119-126
• 96 Brigo B, Serpelloni G. Homeopathic treatment of migraines: a randomized double-blind controlled study of sixty cases (homeopathic remedy versus placebo). Berlin J Res Homoeopath 1991; 1: 98-106
• 97 Whitmarsh TE, Coleston-Shields DM, Steiner TJ. Double-blind randomized placebo-controlled study of homoeopathic prophylaxis of migraine. Cephalalgia 1997; 17: 600-604
• 98 Straumsheim P, Borchgrevink C, Mowinckel P. et al. Homeopathic treatment of migraine: a double blind, placebo controlled trial of 68 patients. Br Hom J 2000; 89: 4-7
• 99 Savage RH, Roe PF. A double blind trial to assess the benefit of Arnica montana in acute stroke illness. Br Hom J 1977; 66: 207-220
• 100 Savage RH, Roe PF. A further double blind trial to assess the benefit of Arnica montana in acute stroke illness. Br Hom J 1978; 67: 210-222
• 101 Weiser M, Strosser W, Klein P. Homeopathic vs conventional treatment of vertigo: a randomized double-blind controlled clinical study. Arch Otolaryngol Head Neck Surg 1998; 124: 879-885
• 102 Dorfman P, Lasserre MN, Tetau M. Préparation à l'accouchement par homéopathie’experimentation en double insu versus placebo. Cahiers Biothérap 1987; 94: 77-81
• 103 Dorfman P, Amodeo C, Riccioti F. et al. Evaluation de l'activité d'arnica 5CH sur les troubles veineux après perfusion prolongée. Cahiers Biothérap 1988; 98 (Suppl): 77-82
• 104 Ernst E, Saradeth T, Resch KL. Complementary treatment of varicose veins’a randomized, placebo-controlled, double-blind trial. Phlebology 1990; 5: 157-163
• 105 Jeffrey SL, Belcher HJ. Use of Arnica to relieve pain after carpal-tunnel release surgery. Altern Ther Health Med 2002; 8: 66-68
• 106 Hart O, Mullee MA, Lewith G, Miller J. Double-blind, placebo-controlled, randomized clinical trial of homoeopathic arnica C30 for pain and infection after total abdominal hysterectomy. J R Soc Med 1997; 90: 73-78
• 107 Stam C, Bonnet MS, van Haselen RA. The efficacy and safety of a homeopathic gel in the treatment of acute low back pain: a multi-centre, randomised, double-blind comparative clinical trial. Br Hom J 2001; 90: 21-28
• 108 Leaman AM, Gorman D. Cantharis in the early treatment of minor burns. Arch Emerg Med 1989; 6: 259-261
• 109 Chapman EH, Weintraub RJ, Milburn MA. et al. Homeopathic treatment of mild traumatic brain injury: a randomized, double-blind, placebo-controlled clinical trial. J Head Trauma Rehabil 1999; 14: 521-542
• 110 Lökken P, Straumsheim PA, Tveiten D. et al. Effect of homoeopathy on pain and other events after acute trauma: placebo controlled trial with bilateral oral surgery. Br Med J 1995; 310: 1439-1442
• 111 Balzarini A, Felisi E, Martini A, De Conno F. Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomised, double-blind clinical trial. Br Hom J 2000; 89: 8-12
• 112 Kulkarni A, Nagarkar BM, Burde GS. Radiation protection by use of homoeopathic medicines. Hahnemann Homoeopath Sand 1998; 12: 20-23
• 113 Oberbaum M, Yaniv I, Ben-Gal Y. et al. A randomized, controlled clinical trial of the homeopathic medication Traumeel S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation. Cancer 2001; 92: 684-690
• 114 Campbell A. Two pilot controlled trials of Arnica montana. Br Hom J 1976; 65: 154-158
• 115 Gaucher C, Jeulin D, Peycru P, Amengual C. A double blind randomized placebo controlled study of cholera treatment with highly diluted and succussed solutions. Br Hom J 1994; 83: 132-134
• 116 van Erp VM, Brands M. Homoeopathic treatment of malaria in Ghana: open study and clinical trial. Br Hom J 1996; 85: 66-70