>> I'm sure he'll[Dale] be more reflective in the
>> future, and I hope we all will be. (Douglas)
> you are much more of an optimist than I <g>
I have been reflecting on this and reading about it for a couple days.
> This disbelief signals to me that you can't explain
> homeopathy with your current world view.
I'm more interested in evidence than world-view. And I'll bet our
world-views are more similar than you think (I love to grow tomatoes).
> Should something come along that could explain how
> homeopathic medicine works to you, you perhaps would
> then be able to explain it to others and then you could
I'm more interested in empirical evidence than in rational explanation.
Rational explanations are a dime a dozen. Every snake-oil salesman (and
scientist with a proposal) has a rational explanation.
> I had a similar experience with acupuncture....
> I know acupuncture works. I just don't have the cognitive
> equipment to make sense of it yet.
I think there is slightly more evidence that acupuncture works, than for
the efficacy of homeopathy. I was curious, so I dug up some
information. Homeopathy was invented by the German Samuel Hahnemann in
the early 19th century, and took root in America during the naturalistic
ferment that also spawned phrenology, animal magnetism, mesmerism,
hydropathy, chiropractic, and osteopathy (Nature Religion in America,
Catherine Albanese, 1990). Although some of these seem to contain
certain efficacious practices, the intellectual frameworks they
represented have been discredited by the advancement of knowledge,
including much you probably take for granted.
I'm interested in the cultural connections between the 19th century
back-to-nature ferment, that spawned these knowledge systems, and waves
of similar ferment during the last couple decades that have produced the
organic foods movement, among other "new age" phenomena.
> The use of the term *fairy story* is a rather familiar
> tactic, though, to denigrate aspects of science one is
> not prepared to comprehend.
You're right. That was rather insensitive of me. One persons fairy
story is anothers religion.
Back to homeopathy. Perhaps it works for obscure reasons, although the
evidence I have seen is pretty weak, especially in light of publication
bias against negative findings. I dug up a couple meta-analytic
studies, and a commentary on the difficulties of performing clinical
trials on these things. Abstracts are concatenated below.
> Keep your critical reading shields up, folks--
TI: Are the clinical effects of homoeopathy placebo effects? A
meta-analysis of placebo-controlled trials.
AU: Linde-K; Clausius-N; Ramirez-G; Melchart-D; Eitel-F; Hedges-L-V;
SO: Lancet (North American Edition) 350(9081): 834-843
AB: Background: Homoeopathy seems scientifically implausible, but has
widespread use. We aimed to assess whether the clinical effect reported
in randomized controlled trials of homoeopathic remedies is equivalent
to that reported for placebo. Methods: We sought studies from
computerized bibliographies and contacts with researchers, institutions,
manufacturers, individual collectors, homoeopathic conference
proceedings, and books. We included all languages. Double-blind and/or
randomized placebo-controlled trials of clinical conditions were
considered. Our review of 186 trials identified 119 that met the
inclusion criteria. 89 had adequate data for meta-analysis, and two sets
of trial were used to assess reproducibility. Two reviewers assessed
study quality with two scales and extracted data for information on
clinical condition, homoeopathy type, dilution, "remedy", population,
and outcomes. Findings: The combined odds ratio for the 89 studies
entered into the main meta-analysis was 2.45 (95% CI 2.05, 2.93) in
favour of homoeopathy. The odds ratio for the 26 good-quality studies
was 1.66 (1.33, 2.08), and that corrected for publication bias was 1.78
(1.03, 3.10). Four studies on the effects of a single remedy on seasonal
allergies had a pooled odds ratio for ocular symptoms at 4 weeks of 2.03
(1.51, 2.74). Five studies on postoperative ileus had a pooled mean
effect-size-difference of -0.22 standard deviations (95% CI -0.36,
-0.09) for flatus, and -0.1 8 SDs (-0.33, -0.03) for stool (both p lt
0.05). Interpretation: The results of our meta-analysis are not
compatible with the hypothesis that the clinical effects of homoeopathy
are completely due to placebo. However, we found insufficient evidence
from these studies that homoeopathy is clearly efficacious for any
single clinical condition. Further research on homoeopathy is warranted
provided it is rigorous and systematic.
Record 6 of 10 - BA on CD January - June 1991
TI: Clinical trials of homeopathy.
AU: KLEIJNEN-J; KNIPSCHILD-P; TER-RIET-G
SO: BRITISH MEDICAL JOURNAL 302(6772): 316-323
AB: Objective: To establish whether there is evidence of the efficacy
of homoeopathy from controlled trials in humans. Design: Criteria based
meta-analysis. Assessment of the methodological quality of 107
controlled trials in 96 published reports found after an extensive
search. Trials were scored using a list of predefined criteria of good
methodology, and the outcome of the trials was interpreted in relation
to their quality. Setting: Controlled trials published world wide. Main
outcome measures: Results of the trials with the best methodological
quality. Trials of classical homoeopathy and several modern varieties
were considered separately. Results: In 14 trials some form of classical
homoeopathy was tested and in 58 trials the same single homoeopathic
treatment was given to patients with comparable conventional diagnoses.
Combinations of several homoeopathic treatments were tested in 26
trials; isopathy was tested in nine trials. Most trials seemed to be of
very low quality, but there were many exceptions. The results showed a
positive trend regardless of the quality of the trial or the variety of
homoeopathy used. Overall, of the 105 trials with interpretable results,
81 trials indicated positive results whereas in 24 trials no positive
effects of homoeopathy were found. The results of the review may be
complicated by publication bias, especially in such a controversial
subject as homoeopathy. Conclusions: At the moment the evidence of
clinical trials is positive but not sufficient to draw definitive
conclusions because most trials are of low methodological quality and
because of the unknown role of publication bias. This indicates that
there is a legitimate case for further evaluation of homoeopathy, but
only by means of well performed trials.
Record 7 of 10 - BA on CD 1/95-6/95
TI: Studies on the efficacy of unconventional therapies: Problems and
AU: Gaus-W; Hoegel-J
SO: Arzneimittel-Forschung 45(1): 88-92
AB: Many unconventional therapies (e. g. dietary, phytotherapy,
acupuncture, homeopathy) are well known and often applied, but their
efficacy has hardly been proven. New trial designs and study components
must be found to meet the specific demands of the particular
unconventional therapy on one hand and keep the high methodological
standard of controlled clinical trials on the other hand. Biometricians
and unconventional therapists are challenged to develop such designs.
Typical problems in designing studies of unconventional therapies
include that placebo is not possible, therapies cannot be masked,
outcome variables are not reliable, therapy is highly individualized,
and studies on the efficacy of soft therapies require many patients and
long treatment periods. Studies with unconventional therapies should be
performed by practitioners (because they use these therapies), but this
leads to further problems. Some solutions are given in examples: A study
is described investigating the herbal remedy Kava-Kava for patients in
the state of anxiety, tension and restlessness; a study on classical
homeopathy for chronic headaches is specified; some designs for dietary
studies in patients with rheumatoid arthritis are compared. A design
called "cross-allocation of patients to two treatments with
randomization option" and the "N-of-1 design", also called "single case
design" are described and discussed The " change-to-open-label design"
could be useful to investigate soft and natural therapies which require
studies with many patients and long-term treatment.
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