Editorial by Professor E Ernst: Weighing the homeopathic evidence—Author's reply
27 December 2017 (online)
Edzard Ernst's Editorial, ‘Weighing the homeopathic evidence’,1 criticises my review, ‘The research evidence base for homeopathy: a fresh assessment of the literature’.[ 2 ] I am glad that Professor Ernst finds my methodological approach and my result ‘remarkable’, for my review set out to be both original and thought-provoking. In an area of clinical research that is in its infancy, I deemed it high time that the evidence for and against homeopathy was viewed from a more realistic standpoint, with innovative suggestions for progress.
As my article makes clear, there are many deficiencies in the current body of research evidence in homeopathy, including its low intrinsic quality, the small volume of published trials, and publication bias. But there are even more fundamental deficiencies in many existing trials that my paper also highlights: these include inappropriate concentration on disease-specific outcomes, and over-emphasis of statistical rather than clinical significance.
Against this background of limited data, it seems to me that a straightforward re-examination of the primary research evidence from published trials is much more relevant than another formal meta-analysis or systematic review—far less a review of systematic reviews.[ 3 ] My method explicitly acknowledges that restricting analysis to the relative number of articles on the individual medical conditions in which statistical evaluation has been published is ‘the optimum question that can be asked of the available evidence base’. The result of this approach—and in full recognition of the above caveats and others[ 1 ]—is that for 8 medical conditions there is evidence of a positive treatment effect of homeopathy. For 20 other medical conditions, there are too little data to draw any conclusions. The obvious deduction from all this is that we need more, and much better directed, research in homeopathy.
There is no denying that homeopathy carries a heavy burden of scientific proof. In my article, I am offering a fresh vision of the present and of future research trials in homeopathy. I have previously indicated the value of clinical observational studies in contributing to building an appropriate evidence base in homeopathy.[ 4 ] We can—we must—move on from here. If my attitude is also optimistic (balanced with a properly scientific perspective), it aims to do justice to the compellingly positive clinical experience of homeopathic practitioners and their patients.
- 1 Ernst E. Editorial: weighing the homeopathic evidence. Homeopathy 2003; 92: 63–64.
- 2 Mathie RT. The research evidence base for homeopathy: a fresh assessment of the literature. Homeopathy 2003; 92: 80–87.
- 3 Ernst E. A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol 2002; 54: 577–582.
- 4 Mathie RT. Clinical outcomes research: contributions to the evidence base for homeopathy. Homeopathy 2003; 92: 56–57.