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Homeopathic remedies improve the health of 70% of patients, reported the Daily Mail (22 November 2005). The research was accurately presented, but limitations in study design and methods used to assess changes in health status mean that the study cannot provide a reliable evaluation of the effectiveness of homeopathy.

On the 22 November 2005 the Daily Mail (1) reported that homeopathic remedies can improve the health of 70% of patients. The article also refers to a study (2) that found that homeopathy is no more effective than placebo, which has previously been covered by Hitting the Headlines (http://www.nelh.nhs.uk/hth/homeopathy.asp)
The newspaper article was based on research published in the Journal of Alternative and Complementary Medicine (3). This was an observational study of 6,544 people with chronic diseases who were referred to a homeopathic hospital out-patient department. The study assessed perceived changes in health following initial consultation and treatment. The research found that 70.7% of people reported a positive improvement in health at follow-up.
The newspaper accurately reports a summary of the research, and considers the limitations of the research presented. Despite the large number of people studied, the lack of a comparison group means that the study cannot provide a reliable evaluation of the effectiveness of homeopathy.

Evaluation of the evidence base for the homeopathic treatment of chronic disease

Where does the evidence come from?

The research was performed by Dr David Spence and colleagues at the Bristol Homeopathic Hospital, NHS Teaching Trust, UK.

What were the authors' objectives?

The objective was to assess the health changes observed following routine homeopathic care in patients with a range of chronic medical conditions.

What was the nature of the evidence?

The research was an observational study of 6,544 consecutive people referred by a GP or hospital specialist to a homeopathic hospital outpatient department. All participants had a diagnosis of chronic disease, and many had already received treatment by one or more hospital specialists. The conditions treated included eczema, asthma, depression and menopausal problems. Participants were both adults and children, with the majority being less than 48 years of age.

What interventions were examined in the research?

Participants received an initial 45-minute consultation and attended 15-minute follow-up appointments to determine any health change. No details were given on the homeopathic treatments administered.

What were the factors of interest?

At each follow-up appointment participants were asked to rate their current state of health using a scale ranging from 'much better' (+3 on the scale) to 'much worse' (- 3 on the scale). The overall outcomes were compared to baseline assessment, and the proportion of participants reporting each category of health change was calculated overall and separately for the most commonly referred diagnosis, and for children (less than 16 years), adult women and men.

What were the findings?

Overall, 70.7% of participants reported a positive health change, with 50.7% rating the health change as 'better' or 'much better'. A further 23.1% of participants reported no change following treatment, and 3.1% reported deterioration. 69.2% of adult women and 65.3% of men reported a positive health change.

The biggest improvements were found in those aged less than 16 years, with 80.5% reporting a positive health change. In this group, 82% of those with eczema and 89% of those with asthma reported an improvement.

What were the authors' conclusions?

The authors conclude that homeopathic interventions improve health in a substantial proportion of patients with a wide range of chronic diseases. Further research, using a range of study designs, is needed in the field of homeopathy.

How reliable are the conclusions?

The study was based on a large cohort of 6,544 consecutive people attending a referral homeopathic hospital outpatient department, with more than 95% attending one or more follow-up appointment. Despite the large number of people studied, the lack of a comparison group means that the study cannot provide a reliable evaluation of the effectivness of homeopathy. The method used to determine health change relied entirely on the participants' self-reported assessment using a subjective scale. This is a very weak form of assessment (for example, it is unclear how meaningful was the improvement in the 20% of participants who reported being 'slightly better' after homeopathic treatment); the lack of an objective measurement of improvement severely limits the validity of the findings.

No details were given on the homeopathic remedies given, the severity of condition or any other potential factors that may lead to an improvement in condition. Consequently, the results of additional studies should be drawn on to determine the effectiveness of homeopathic remedies in people with chronic disease.

Overall, the study tells us that many people do feel they receive some benefit from being referred to and treated by homeopathic medicine, however, it does not demonstrate the effectiveness of homeopathic medicine. In addition, as acknowledged by the newspaper report, the results of this study contradict the findings of a systematic review of 110 trials of homeopathy and 110 trials of conventional medicine, which found that homeopathic remedies are no better than placebo (2).

Systematic reviews

Information staff at CRD searched for systematic reviews relevant to this topic. Systematic reviews are valuable sources of evidence as they locate, appraise and synthesize all available evidence on a particular topic.

There was one related systematic review identified on the Cochrane Database of Systematic Reviews (CDSR) (4) and one review which is currently being completed and will be available in the future (5). Four related systematic reviews were identified on the Database of Abstracts of Reviews of Effects (DARE) (6-9).

References and resources

1. Homeopathic remedies that work for 70pc of patients. Daily Mail, 22 November 2005, p22.

2. Shang AS, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JAC, Pewsner D, Egger M. Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Lancet 2005;336:726-732.

3. Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study. Journal of Alternative and Complementary Medicine 2005;11(5):793–798.

4. McCarney RW, Linde K, Lasserson TJ. Homeopathy for chronic asthma. The Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD000353. DOI: 10.1002/14651858.CD000353.pub2.

5. Kassab S, van Haselen R, Fisher P, McCarney R. Homeopathy for adverse effects of cancer management. [Cochrane Protocol] The Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004845. DOI: 10.1002/14651858.CD004845.

6. Ernst E. Homeopathic prophylaxis of headaches and migraine: a systematic review. Journal of Pain and Symptom Management 1999;18(5):353-357. [DARE Abstract]

7. Long L, Ernst E. Homeopathic remedies for the treatment of osteoarthritis: a systematic review. British Homoeopathic Journal 2001;90(1):37-43. [DARE Abstract]

8. Mulrow C D, Ramirez G, Cornell J E, Allsup K. Defining and managing chronic fatigue syndrome. Rockville, MD, USA: Agency for Healthcare Research and Quality 2001:199. [DARE Abstract]

9. Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges L V, Jonas W B. Are the clinical effects of homoeopathy placebo effects: a meta-analysis of placebo-controlled trials. Lancet 1997;350:834-843. [DARE Abstract]