[Omeo33] Art 0866 - Homeopathy, 2008, 97 (4), 169-177

[Gino Santini]

The 2005 meta-analysis of homeopathy: the importance of post- 
publication data
A.L.B. Rutten and C.F. Stolper

Background - There is a discrepancy between the outcome of a meta- 
analysis published in 1997 of 89 trials of homeopathy by Linde et al  
and an analysis of 110 trials by Shang et al published in 2005, these  
reached opposite conclusions. Important data were not mentioned in  
Shang et al's paper, but only provided subsequently.
Questions - What was the outcome of Shang et al's predefined  
hypotheses? Were the homeopathic and conventional trials comparable?  
Was subgroup selection justified? The possible role of ineffective  
treatments. Was the conclusion about effect justified? Were essential  
data missing in the original article?
Methods - Analysis of post-publication data. Re-extraction and  
analysis of 21 higher quality trials selected by Shang et al with  
sensitivity analysis for the influence of single indications. Analysis  
of comparability. Sensitivity analysis of influence of subjective  
choices, like quality of single indications and of cut-off values for  
‘larger samples’.
Results - The quality of trials of homeopathy was better than of  
conventional trials. Regarding smaller trials, homeopathy accounted  
for 14 out of 83 and conventional medicine 2 out of 78 good quality  
trials with n < 100. There was selective inclusion of unpublished  
trials only for homeopathy. Quality was assessed differently from  
previous analyses. Selecting subgroups on sample size and quality  
caused incomplete matching of homeopathy and conventional trials. Cut- 
off values for larger trials differed between homeopathy and  
conventional medicine without plausible reason. Sensitivity analyses  
for the influence of heterogeneity and the cut-off value for ‘larger  
higher quality studies’ were missing. Homeopathy is not effective for  
muscle soreness after long distance running, OR = 1.30 (95% CI 0.96– 
1.76). The subset of homeopathy trials on which the conclusion was  
based was heterogeneous, comprising 8 trials on 8 different  
indications, and was not matched on indication with those of  
conventional medicine. Essential data were missing in the original  
paper.
Conclusion - Re-analysis of Shang's post-publication data did not  
support the conclusion that homeopathy is a placebo effect. The  
conclusion that homeopathy is and that conventional is not a placebo  
effect was not based on comparative analysis and not justified because  
of heterogeneity and lack of sensitivity analysis. If we confine  
ourselves to the predefined hypotheses and the part of the analysis  
that is indeed comparative, the conclusion should be that quality of  
homeopathic trials is better than of conventional trials, for all  
trials (p = 0.03) as well as for smaller trials (p = 0.003).

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