Who’s biased? The Lancet declares ‘the end of homeopathy’
Statistics: the only science that enables different experts using the same figures to draw different conclusions – Even Esar.
For 200 years homeopathy has suffered the slings and arrows of a frustrated medical establishment. Frustrated because they cannot understand how homeopathy’s potentized remedies can work and frustrated by the fact that millions of patients around the World find that homeopathic treatments have worked for them nonetheless. That frustration has now led the editor of the Lancet to publish a flawed piece of statistical analysis (1) and trail it widely through the media in one more desperate attempt to kill homeopathy off.
The study featured is a comparative statistical analysis of a number of placebo-controlled trials of homeopathy and conventional medicines and not hard research in itself. The study talks a lot about the effect of bias in research studies – both homeopathic and conventional. Yet statistics themselves are famous for their potential to be biased.
The researchers in this study set out their prejudices about homeopathy from the start when in the first paragraph they declare that ‘the specific effects of homeopathy seem implausible’. Then in the discussion section of the paper they make the following extraordinary statement: We assumed that the effects observed in placebo-controlled trials of homeopathy could be explained by a combination of methodological deficiencies and biased reporting. Conversely, we postulated that the same biases could not explain the effects observed in comparable placebo-controlled trials of conventional medicine. Our results confirm these hypotheses.
In his editorial the Lancet editor writes: “Going one step further, the Swiss Government, after a 5 year trial, has now withdrawn insurance cover for homeopathy and four other complementary treatments because they did not meet efficacy and cost-effectiveness criteria.” The Lancet paper was used to justify this decision. What he doesn’t mention is that the study he has published is one of several studies carried out to inform the Swiss Government on the place of complementary therapies in the Swiss healthcare insurance scheme.
A second far more practical study had as its results that complementary medicine (including acupuncture, homeopathy and phytotherapy) is as effective as conventional medicine in a range of complicated and chronic conditions and at least as cost-effective. Of the therapies included homeopathy had the best results. However, the results of this study were suppressed and their dissemination actually forbidden on pain of legal prosecution until after the Government had stopped the insurance scheme that paid doctors to provide complementary therapies.
Furthermore when the Government appointed commission wrote in its draft report that homeopathy should continue to be included in the insurance scheme pressures were brought to bear to have the paragraph removed from the final report.
So bias and selective publishing of results are present at all levels. The editor of the Lancet is as known for his antipathy to homeopathy in the UK as Professor Egger is in Switzerland. The Lancet recently rejected a UK study of a large number of cases of homeopathic treatment provided in an NHS setting which showed high levels of effectiveness and high levels of patient satisfaction. No doubt the study from Germany featured in the article below this one would have been rejected too.
As was quoted from Kant in the Lancet editorial ‘we see things not as they are, but as we are.’ To be generous to the Lancet editor however he did get it right when at the end of his editorial he tacitly implied that homeopathy offers personalized care to patients. Good homeopathic treatment is individualized to each patient. This is why it works and why patients will continue to want it.
NB a considered critique of the statistical analysis in the Lancet paper will follow this short article at a later date.
1) Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Aijang Shang, Krain Huwiler-Mûntener, Linda Nartey, Peter Juni, Stephan Dörig, Jonathon A C Sterne, Daniel Pewsner, Matthias Egger Lancet (2005); 366: 726-32
These pre-assumptions exhibit extreme bias from the start of the study and are totally inappropriate in a study that sets out to objectively compare two different methodologies. Here alone the study fails by its own standards – not to mention by proper scientific standards. New German study shows homeopathic treatment to be superior to conventional treatments across a range of conditions and with similar cost levels
The latest volume of Complementary therapies in Medicine contains a report of a research study evaluating the effectiveness of homeopathy versus conventional treatment in routine care. The analyses of 493 patients (315 adults, 178 children) indicated greater improvement in patients’ assessments after homeopathic versus conventional treatment (adults: homeopathy from 5.7 to 3.2;conventional, 5.9—4.4;p = 0.002; children from 5.1 to 2.6 and from 4.5 to 3.2).
Physician assessments were also more favorable for children who had received homeopathic treatment (4.6—2.0 and 3.9—2.7; p < 0.001). Overall costs showed no significant differences between both treatment groups (adults, D 2155 versus D 2013, p = 0.856;children, D 1471 versus D 786, p = 0.137).
The study report concludes that: patients seeking homeopathic treatment had a better outcome overall compared with patients on conventional treatment, whereas total costs in both groups were similar.
Outcome and costs of homeopathic and conventional treatment strategies: A comparative cohort study in patients with chronic disorders.