Recent surveys have come to different conclusions. Edzard Ernst, Michael Hyland and Pamela Stevens argue their corners.

No value beyond placebo

Edzard Ernst weighs the evidence

This question receives vastly different answers depending on who is being asked. A leaked draft report commissioned by the Prince of Wales recently claimed that up to £480 million could be cut from the bill for prescription drugs within the NHS if only 10 per cent of British GPs were to offer homeopathy as an alternative to standard drugs.(1)

Such optimism is also supported by a widely circulated draft WHO report on homeopathy which states that the ‘majority’ of research shows ‘that homeopathy is superior to placebo in placebo controlled trials and is equivalent to conventional medicines both in humans and animals’.(2)

At the same time as all this is being reported, a Lancet editorial signals the end of homeopathy : ‘Now doctors need to be bold and honest with their patients about homeopathy’s lack of benefit, and with themselves about the failings of modern medicine to address patients’ needs for personalised care’.(3)

Hardest evidence

Confused? I can’t blame you! Emotions have always flown high in the 200-year history of homeopathy. But emotions are rarely productive; what is needed is evidence which avoids double standards and convinces all concerned.

Perhaps the hardest evidence so far comes from a comparison of all placebo-controlled randomised trials of homeopathy with matched studies of conventional medicines.(4) The authors concluded that the results were ‘compatible with the notion that the clinical effects of homeopathy are placebo effects’.

Surely we cannot pronounce a final verdict over homeopathy on the basis of one meta-analysis! I would agree with this sentiment, but the fact is that a recent overview reviewed 11 further independent systematic reviews.(5) Collectively they failed to provide strong evidence in favour of homeopathy.

In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo.

Weaker and weaker

The reliable evidence that homeopathic remedies are any different from placebos seems to get weaker and weaker. It has reached a point, I think, where we have to seriously doubt their value beyond placebo. The Lancet sums it up well: ‘For too long, a politically correct laissez-faire attitude has existed towards homeopathy, but now there are signs of enlightenment’.(3)

References

• M Henderson, A Pierce (2005). Prince plots alternative treatments for the NHS. The Times, 24 August 24, p.1
• M. McCarthy (2005). Critics slam draft WHO report on homoeopathy. Lancet, 366, pp. 705-6
• The end of homoeopathy. Lancet 2005, 366 p.690.
• A Shang, K Huwiler-Muntener, L Nartey, P Juni, S Dorig, J A Sterne et al. (2005). Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet, 366 pp.726-732
• E Ernst (2002).A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol, 54 pp.577-82

Edzard Ernst is Professor of Complementary Medicine at the University of Exeter