1997 [ ]
1: one person
2-CH and 2-IN: see below
3: Unclear
a 2-CH: A performing + B checking parts of A’s results. 2-IN: two persons independently
b List published on website of institution of senior author 4 months after publication
All six MAs used one main clinical outcome for each trial or trial comparison. For the MA conducted by Cucherat [ 8 ], this was the primary outcome as reported in the trials (cf. Section ' Eligibility criteria ', above); for the other MAs, a predefined hierarchical list of criteria for extraction of the main outcome was used (Suppl. Table 9 ).
For two MAs (Mathie 2014 and 2017) [ 10 , 11 ], a prepublished protocol was available; for two MAs (Linde 1997. Cucherat [ 6 , 8 ]), a protocol was referred to in the publication; and for two MAs (Linde 1998, Shang 2005 [ 7 , 9 ]), a protocol was not mentioned in the publication, while one single design criterion (outcome extraction in both cases) was explicitly stated as predefined.
High-quality trials.
High-quality trials according to our criteria (cf. Section ' Data items ' / ' Primary outcome ', above) were performed in four MAs [ 6 , 9 – 11 ]. The criteria for high-quality trials were described as predefined (Linde 1997) [ 6 ] or fully (Mathie 2017) [ 11 ] or partially (Mathie 2014) [ 10 ] defined in a prepublished protocol. One MA did not mention this aspect (Shang [ 9 ]). The criteria for high-quality trials were as follows:
The MA conducted by Linde (1997) [ 6 ] used a combination of two score-based instruments:
Criteria for high-quality trials
Linde (1997) [ ] | Shang (2005) [ ] | Mathie 2014 [ ] and 2017 [ ] | ||
---|---|---|---|---|
Name of quality instruments | Jadad score | Internal Validity scale | [Not stated] | Cochrane risk-of-bias appraisal tool (RoB 1) |
(1: used; 0: not used) | ||||
1. Generation of allocation sequence adequate | 1 | 1 | 1 | 1 |
2. Allocation concealment adequate | 0 | 1 | 1 | 1 |
3. Double-blinding adequate | 1 | 0 | 1 | 0 |
4. …Blinding of patients | 0 | 1 | 0 | 1 |
5. …Blinding of evaluators | 0 | 1 | 0 | 1 |
6. Baseline comparability adequate | 0 | 1 | 0 | 0 |
7. No selection bias after randomisation | 0 | 1 | 0 | 0 |
8. Completeness of outcome data | 0 | 0 | 0 | 1 |
9. Dropout/withdrawals described | 1 | 0 | 0 | 0 |
10. Intention-to-treat analysis | 0 | 0 | 1 or 0 | 0 |
11. Statistical analysis adequate | 0 | 1 | 0 | 0 |
12. No selective outcome reporting | 0 | 0 | 0 | 1 |
13. No other sources of bias | 0 | 0 | 0 | 1 |
8 | 3 or 4 | 7 |
a Mathie (2014 and 2017): Blinding of participants and study personnel
b N quality components in Jadad score + Internal Validity scale, excluding component no. 3 in Jadad, which is redundant with no. 4 and 5 in Internal validity scale
The instruments used in the following MAs consisted of sets of mandatory criteria, all of which were to be fulfilled.
The MAs conducted by Mathie (2014 and 2017) [ 10 , 11 ] used the Cochrane risk-of-bias tool (RoB, version 2011) [ 40 ]: low risk of bias for items 1–2 and 4–5 in Table Table5, 5 , low risk for two of the three items 8 and 12–13 and low or uncertain risk for one of the latter four items.
In the MA conducted by Shang [ 9 ], the number of quality components used was variously described as 3 or 4, corresponding to fulfilment of items (1–3) or (1–3 + 10) in Table Table5. 5 . Lüdtke [ 32 ] interpreted Shang [ 9 ] as having used 3 components (Suppl. Table 29 ). Details in support of either 3 or 4 components are presented in Suppl. Table 11 .
The high-quality criteria were based on 8 [ 6 ], 7 [ 10 , 11 ] and either 3 or 4 quality components [ 9 ] (Table (Table5 5 ).
The total number of methodological quality components assessed in each MA (including components of high-quality criteria as well as other components) ranged from 3 [ 8 ] to 10 [ 6 , 7 ], details in Suppl. Table 12 .
Associations between quality components and outcome were analysed with hypothesis testing in four MAs (not in the MA conducted by Linde (1998) [ 7 ] and Cucherat [ 8 ]).
Cumulative MA with stepwise removal of trials according to increasing quality categories was performed in four MAs using interval-scaled [ 7 , 10 , 11 ] or rank-ordered [ 8 ] categories. Of the two other MAs, one [ 7 ] had outcome analysis in 4 ranked quality subgroups instead of cumulative MA.
Statistical heterogeneity testing was performed in four MAs (not in the MAs conducted by Linde (1998) [ 7 ] and Cucherat [ 8 ]); all but one MA [ 7 ] included an assessment of publication bias/small study bias (Suppl. Table 14 ).
Potential conflicts of interest were stated and explained for at least one author in two MAs (Mathie 2014 and 2017) [ 10 , 11 ]; a statement of no conflicts of interest for any author was included in one MA (Shang) [ 9 ], while this issue was not addressed in the three other MAs.
Number of trials, trial comparisons and trial reports.
For each MA, between 150 and 359 full-text records were assessed for eligibility (data available for four MAs) and between 16 and 119 trials were eligible for SR, including 16–110 trials with extractable data for MA. Altogether, 182 different trials (or in some cases, trial comparisons) reported in 165 different publications or other trial reports were included in the 6 MAs. Of these, n = 88 trials were included in 1 MA, 65 trials in 2 MA, 24 trials in 3 MA and 5 trials in 4 MA, with a total of 310 trials or trial comparisons (Suppl. Table 15 ). All following descriptions refer to these 310 trials.
Summary descriptive data on 12 different trial properties (excluding design, trial quality and results) were presented, ranging from 3 [ 8 ] to 9 [ 7 ] items per MA (Suppl. Table 16 ).
All six MAs had at least one table with characteristics of individual trials. A total of 38 different items were presented (or summarily stated as present/absent in all trials), ranging from 8 (Shang [ 9 ]) to 33 items (Mathie 2017 [ 11 ]) per MA (Suppl. Table 17 ). The most frequently reported items were as follows:
The trials were published in the period 1943–2014 (Table (Table6). 6 ). The median trial sample size per trial was in the range of 45–97 patients with a minimum sample size of 5–28 and a maximum size of 175–1573 patients. The trials of each MA had been performed in 11–15 countries (data available for four MAs). The countries where each trial was performed was reported in three MAs [ 7 , 10 , 11 ]; the most common countries were the UK ( n = 18 trials among the three MAs, multiple responses possible), Germany ( n = 17), USA ( n = 9) and France and India (both with n = 6 trials) (Suppl. Table 18 ). The most common languages of trial publications were English (range 39–95% of trials), German (5–29%) and French (0–28%) (Table (Table6 6 ).
Literature searches, characteristics of trials with extractable data for meta-analysis
Linde (1997) [ ] | Linde (1998) [ ] | Cucherat (2000) [ ] | Shang (2005) [ ] | Mathie (2014) [ ] | Mathie (2017) [ ] | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No data | No data | 150 | 156 | 348 | 359 | |||||||
Assessed for eligibility | 186 | No data | 118 | No data | No data | No data | ||||||
Eligible for systematic review | 119 | 31 | 17 | 110 | 32 | 75 | ||||||
Extractable data for meta-analysis | N = 89 | N = 18 | N = 17 | N = 110 | N = 22 | N = 54 | ||||||
1943–1995 | 1980–1997 | 1980–1998 | 1960–2003 | 1994–2011 | 1976–2014 | |||||||
Total | 9283 | 1019 | 2480 | 12,879 | 1335 | 5739 | ||||||
Mean | 149 | 38 | 133 | 117 | 33 | 101 | ||||||
Median | 60 | 45 | 97 | 65 | 57 | 64 | ||||||
Interquartile range | 39–120 | 30–74 | 53–237 | 37–104 | 40–71 | 39–131 | ||||||
Total range | 5–1270 | 10–175 | 28–478 | 10–1573 | 23–175 | 18–478 | ||||||
13 | 12 | No data | No data | 11 | 15 | |||||||
% | % | % | % | % | % | |||||||
English | 35 | 39.3% | 16 | 88.9% | 9 | 52.9% | 57 | 51.8% | 21 | 95.5% | 37 | 68.5% |
French | 25 | 28.1% | 0 | 0.0% | 4 | 23.5% | 22 | 20.0% | 0 | 0.0% | 2 | 3.7% |
German | 26 | 29.2% | 1 | 5.6% | 4 | 23.5% | 28 | 25.5% | 1 | 4.5% | 13 | 24.1% |
Other | 3 | 3.4% | 1 | 5.6% | 0 | 0.0% | 3 | 2.7% | 0 | 0.0% | 2 | 3.7% |
Total | 89 | 100.0% | 18 | 100.0% | 17 | 100.0% | 110 | 100.0% | 22 | 100.0% | 54 | 100.0% |
Data on age groups and gender were available in three MAs [ 7 , 10 , 11 ] with a total of 94 trials (multiple responses possible). A total of 14.9% ( n = 14/94) of all trials included children only, 55.3% ( n = 52) included adults only and 29.8% ( n = 28) included both adults and children or unknown. A total of 14.9% ( n = 14/94) of trials included only females; 2.1% ( n = 2) of trials included only males; and 83.0% ( n = 78) of trials included both genders or did not report these data (data on individual MAs in Suppl. Table 19 ).
Indications for all 310 trials (multiple responses possible) were coded according to ICD-10:
The intervention was I-HOM in all trials for 2 MAs [ 7 , 10 ] and in 0–18% of trials of the four other MAs. In these four MAs, the NI-HOM intervention was clinical homoeopathy in 44–71% of trials, complex homoeopathy in 6–44% (Mathie 2017 [ 11 ]: including ‘combination products’) and isopathy in 6–13% (Table (Table7). 7 ). The homoeopathic products used were high potencies only (≥ C12 or ≥ D24) in 29–39% of trials.
Interventions, metric of main outcome, trial results a
Meta-analysis | Linde (1997) [ ] | Linde (1998) [ ] | Cucherat (2000) [ ] | Shang (2005) [ ] | Mathie (2014) [ ] | Mathie (2017) [ ] | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
trials | 85 | 22 | 17 | 110 | 22 | 54 | ||||||
% | % | % | % | % | % | |||||||
Individualised | 13 | 14.6% | 18 | 100.0% | 3 | 17.6% | 18 | 16.4% | 22 | 100.0% | 0 | 0.0% |
Non-individualised | ||||||||||||
Clinical homoeopathy | 49 | 55.1% | 0 | 0.0% | 12 | 70.6% | 48 | 43.6% | 0 | 0.0% | 23 | 42.6% |
Complex homoeopathy | 20 | 22.5% | 0 | 0.0% | 1 | 5.9% | 35 | 31.8% | 0 | 0.0% | 24 | 44.4% |
Isopathy | 7 | 7.9% | 0 | 0.0% | 1 | 5.9% | 8 | 7.3% | 0 | 0.0% | 7 | 13.0% |
Unclear | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 1 | 0.9% | 0 | 0.0% | 0 | 0.0% |
Yes | 31 | 34.8% | 7 | 38.9% | 5 | 29.4% | No data | 8 | 36.4% | 21 | 38.9% | |
No | 58 | 65.2% | 3 | 16.7% | 8 | 47.1% | No data | 9 | 40.9% | 33 | 61.1% | |
Unclear | 0 | 0.0% | 8 | 44.4% | 4 | 23.5% | No data | 5 | 22.7% | 0 | 0.0% | |
Binary | 74 | 83.1% | 16 | 88.9% | No data | No data | 16 | 72.7% | 23 | 42.6% | ||
Continuous or rank-ordered | 15 | 16.9% | 2 | 11.1% | No data | No data | 6 | 27.3% | 31 | 57.4% | ||
HOM > PLAC significant | 38 | 42.7% | 6 | 33.3% | 11 | 64.7% | 40 | 36.4% | 3 | 13.6% | 15 | 27.8% |
HOM > PLAC not significant | 37 | 41.6% | 8 | 44.4% | 3 | 17.6% | 51 | 46.4% | 12 | 54.5% | 26 | 48.1% |
PLAC > HOM not significant | 14 | 15.7% | 4 | 22.2% | 3 | 17.6% | 18 | 16.4% | 7 | 31.8% | 13 | 24.1% |
PLAC > HOM significant | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 1 | 0.9% | 0 | 0.0% | 0 | 0.0% |
a Data extracted from tables of individual trials (Shang 2005: in part from summarised data) in publication
The main outcome was binary in 43–89% of trials. The main outcome analysis showed a significant positive effect of homoeopathy compared to placebo in 14–65% (weighted mean 36.5% ( n = 113 of 310 trials), a nonsignificant superiority of homoeopathy in 18–55% (weighted mean 44.2%), a nonsignificant superiority of placebo in 16–32% (mean 19.0%) and a significant positive effect of placebo compared to homoeopathy in 0–1% (0.3%, n = 1 trial) (Table (Table7 7 ).
Risk of bias (methodological quality) of trials
For 10 different methodological quality components, the number of trials fulfilling the respective criterion was assessed in at least two MAs, with a total of 43 analyses (Table (Table8, 8 , components 1–10). Fulfilment rates ranged from 17% (allocation concealment adequate in the MAs conducted by Mathie (2017) [ 11 ]) to 100% (8 cases); 44% ( n = 19/43) of analyses showed a fulfilment rate of ≥ 50%. Weighted mean fulfilment rates for each of the 10 components (multiple responses possible, as trials could be included in more than one MA) ranged from 20% (no funding-related vested interests in the MAs conducted by Mathie (2014) [ 10 ] and (2017) [ 11 ]) to 89% (publication format = journal article in all six MAs). Three components (journal article, double blinding adequate, no selective outcome reporting) had weighted average fulfilment rates above 75%.
Risk of bias (methodological quality) of trials: criteria used in ≥ 2 meta-analyses
Quality component | Linde (1997) [ ] | Linde (1998) [ ] | Cucherat (2000) [ ] | Shang (2005) [ ] | Mathie (2014) [ ] | Mathie (2017) [ ] | All MA | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Generation of allocation sequence adequate | 64 | 72 | 15 | 83 | 17 | 100 | 27 | 25 | 11 | 50 | 19 | 35 | 153 | 49 |
2. Allocation concealment adequate | 34 | 38 | 9 | 50 | 17 | 100 | 49 | 45 | 6 | 27 | 9 | 17 | 124 | 40 |
3. Double-blinding adequate | 81 | 91 | 18 | 100 | 16 | 94 | 101 | 92 | 15 | 68 | 25 | 46 | 256 | 83 |
4. Dropout handling adequate / ITT analysis / complete outcome data | 28 | 31 | 6 | 33 | ND | ND | 33 | 30 | 9 | 41 | 20 | 37 | 96 | 33 |
5. No selective outcome reporting | ND | ND | ND | ND | ND | ND | ND | ND | 19 | 86 | 40 | 74 | 59 | 78 |
6. Primary outcome measure stated | 21 | 24 | 7 | 39 | 17 | 100 | ND | ND | ND | ND | ND | ND | 45 | 36 |
7. Journal article | 76 | 85 | 16 | 89 | 15 | 88 | 94 | 85 | 22 | 100 | 54 | 100 | 277 | 89 |
8. Peer-reviewed journal article | 23 | 26 | 10 | 56 | ND | ND | 45 | 41 | 22 | 100 | 54 | 100 | 154 | 53 |
9. No funding-related vested interest | ND | ND | ND | ND | ND | ND | ND | ND | 4 | 18 | 11 | 20 | 15 | 20 |
10. No other risk of bias | ND | ND | ND | ND | ND | ND | ND | ND | 13 | 59 | 26 | 48 | 39 | 51 |
High-quality trials | 26 | 29 | ND | ND | ND | ND | 21 | 19 | 3 | 14 | 3 | 6 | 53 | 19 |
Total trials | 89 | 100 | 18 | 100 | 17 | 100 | 110 | 100 | 22 | 100 | 54 | 100 | 310 | 100 |
MA meta-analyses , ITT intention to treat, ND no data
a Linde (1999) [ 30 ]: explicitly randomised
b Mathie (2014 and 2017) [ 10 , 11 ]: ‘Blinding of participants and study personnel’ and ‘Blinding of evaluators’ were assessed separately
c Linde (1997) [ 6 ] and Shang [ 9 ] : Medline-indexed
In the MA conducted by Linde (1997) [ 6 ], 23.6% ( n = 21/89) of trials had a predefined primary outcome (effect estimate after sample restriction to these trials reported in Suppl. Table 28 ). In the MA conducted by Cucherat [ 8 ], only trials with one single ‘clearly defined’ primary outcome were eligible.
In the MAs conducted by Mathie (2014 and 2017) [ 10 , 11 ], the risk of outcome reporting bias was assessed in Domain V of the Cochrane RoB tool by comparison of the results section with the protocol or, if no protocol was available, with the methods section of publications. In the MA conducted by Mathie (2014) [ 10 ], freedom from risk of outcome reporting bias was rated as ‘yes’ in 86.4% ( n = 19/22) of trials in the MA, ‘uncertain’ in 4.5% ( n = 1) and ‘no’ in 9.1% ( n = 2). In the MA conducted by Mathie (2017) [ 11 ], the corresponding ratings were ‘yes’ in 74.1% ( n = 40/54) of the trials in the MA, ‘uncertain’ in 9.3% ( n = 5) and ‘no’ in 16.7% (n = 9) (Table (Table8, 8 , component no. 5). Effect estimates for the 19 and 40 ‘yes’-rated trials, respectively, were not published.
The proportion of high-quality trials ranged from 6% ( n = 3/54) of trials analysed by Mathie (2017) [ 11 ] to 29% ( n = 26/89) of trials analysed by Linde (1997) [ 6 ] (Table (Table8). 8 ). Notably, the criteria for ‘high quality’ differed widely among the MAs:
For the three MAs using a set of mandatory criteria for ‘high-quality’ (Shang with 3 or 4 criteria; Mathie (2014) [ 10 ] and (2017) [ 11 ] with 7 criteria each), methodological quality was compared with the quality of other trials, assessed according to identical criteria:
Risk of bias of trials of systematic reviews, evaluated with the Cochrane RoB tool (2011), domains I, II, IIIa, IIIb, IV and V
Mathie (2014) [ ] | Mathie (2017) [ ] | Cochrane reviews | Non-Cochrane reviews | |||||
---|---|---|---|---|---|---|---|---|
systematic reviews | 1 | 1 | 100 | 18 | ||||
trials | 32 | 75 | 1242 | 424 | ||||
Percent | Percent | Percent | Percent | |||||
A. Low risk | 1 | 3.1% | 3 | 4.0% | 74 | 6.0% | 25 | 5.9% |
B. Uncertain risk | 12 | 37.5% | 27 | 36.0% | 407 | 32.8% | 226 | 53.3% |
C. High risk | 19 | 59.4% | 45 | 60.0% | 761 | 61.3% | 173 | 40.8% |
Total | 32 | 100.0% | 75 | 100.0% | 1242 | 100.0% | 424 | 100.0% |
Heterogeneity in the full sample.
Significant statistical heterogeneity across trials was found in 3 MAs [ 6 , 9 , 11 , 30 ] and was not found in 1 MA (Mathie 2014) [ 10 ], while heterogeneity was not assessed in 2 MAs [ 7 , 8 ] (Suppl. Table 23 ). Notably, in the MA conducted by Cucherat [ 8 ], the likelihood of statistical heterogeneity because of clinical heterogeneity was stated as a major reason for choosing p value combination instead of meta-analytic effect estimation.
In the MA conducted by Linde (1997/1999) [ 6 , 30 ], heterogeneity was τ -squared 0.43 in the full sample ( n = 89 trials). After sample restriction to trials with higher methodological quality, heterogeneity was reduced in 6 of 7 univariate analyses, with τ -squared ranging from 0.31 for double-blind trials ( n = 81) to 0.41 for explicitly randomised trials ( n = 64). In one multivariate analysis, heterogeneity was reduced to τ -squared = 0.28 for explicitly randomised trials (Suppl. Table 23 ).
In the MA conducted by Mathie (2017) [ 11 ], heterogeneity (I-squared 65%) was not reduced after the ‘trim-and-fill’ procedure for funnel plot asymmetry (FPA, I-squared 79%).
Unavailable trials.
Extensive searches for potentially eligible trials were performed for five MAs (not Linde 1998) [ 7 ], and unpublished trials were eligible for three MAs [ 6 , 8 , 9 ] but not for the two MAs conducted by Mathie [ 10 , 11 ].
Data on unavailable trials were reported for three MAs:
Mathie (2013) [ 3 ] identified the following:
Funnel plot inspection was performed in four MAs. Funnel plots were constructed by plotting the effect estimate for each trial—expressed as the log odds ratio [ 6 , 9 , 10 ] or standardised mean difference (Mathie 2017 [ 11 ])—against the standard error. In three MAs [ 6 , 9 , 11 ], FPA was found, with trials with higher standard error having larger effects. In one MA (Mathie 2014 [ 10 ]), the funnel plot was symmetric. Egger’s test was significant in the first three MAs but not in the MA conducted by Mathie (2014) [ 10 ] (Suppl. Table 25 ).
Trim-and-fill tests were performed in three MAs [ 6 , 8 , 11 ]. Random effects and nonparametric selection models to assess possible missing trials were used in the MA conducted by Linde (1997) [ 6 ]. Under different conditions, the number of fictive additional trials with zero effect required to change results from a significant to a nonsignificant superiority of homoeopathy ranged from 11 (Mathie (2017) [ 11 ]) to 4511 (Linde (1997) [ 6 ], fixed effects model) (Suppl. Table 26 ).
Sterne (2001) [ 36 ] constructed a funnel plot of n = 34 trials with ‘adequate concealment’ + ‘double-blinding’ from the MA conducted by Linde (1997) [ 6 ] (not the n = 26 high-quality trials according to Linde (1997) [ 6 ]). On inspection, FPA was found, and the corresponding tests were significant (rank correlation: p = 0.014; regression: p < 0.001).
Lüdtke (2008) [ 32 ] constructed a funnel plot of the 21 high-quality trials analysed by Shang [ 9 ] by plotting the log odds ratio against the standard error. The plot showed a cluster of 18 largely symmetric trials and 3 extreme outliers, with 2 strongly favouring homoeopathy and 1 strongly favouring placebo. Egger’s test showed a large but not significant FPA (asymmetry coefficient 0.40, p = 0.17); this was also the case for the 8 largest high-quality trials (1.15, p = 0.94, funnel plot not shown) [ 32 ] (Suppl. Table 25 ).
Associations between methodological quality or other subgroups and effect estimates were analysed in 4 MAs (Linde 1997 [ 6 ], Shang [ 9 ], Mathie 2014 [ 10 ] and 2017 [ 11 ], Suppl. Table 27 ).
Linde (1997 [ 6 ] and 1999 [ 30 ]): The authors analysed uni- and multivariate associations between four single quality components and the effect estimate and found significant associations for ‘double blinding’ (uni- and multivariate) and ‘explicitly randomised’ (multivariate) but not for ‘adequate concealment of random allocation’ nor ‘complete follow-up’ (neither uni- nor multivariate). Univariate analyses showed significant associations between three composite quality measures (A: Jadad scale > 2; B: Internal validity score > 4.5; C: A and B) and effect estimate. On the other hand, scatter plots of the Jadad scale and internal validity score against odds ratios showed no clear linear relationships (Suppl. Table 27 ).
Linde (1997) [ 6 ] / Sterne [ 36 ]: The authors analysed uni- and multivariate associations between ‘English language publication’ and ‘Medline-indexed publication’, respectively, and effect estimates: two of four analyses showed significant associations (‘English language’, univariate + ‘Medline-indexed’, multivariate Suppl. Table 27 ).
Shang [ 9 ] analysed univariate associations between six single quality components and effect estimates, and significant associations were found for three (‘Medline-indexed’, ‘double-blinding’, ‘adequate generation of allocation sequence’). Likewise, a significant association was found for high-quality trials (Suppl. Table 27 ). In multivariate analyses, as summarised by the authors ‘the standard error of the log odds ratio (asymmetry coefficient) was the dominant variable. Coefficients of other variables, including study quality, were attenuated and became non-significant’ (Shang [ 9 ], pp.929-930).
The MAs conducted by Mathie (2014 [ 10 ] and 2017 [ 11 ]) revealed no significant associations between ‘publication free of vested interest’ and effect estimates (both MAs, Suppl. Table 27 ).
According to our ROBIS [ 13 ] assessments, the risk of bias was low in three MAs (Linde 1997, Mathie 2014 & 2017 [ 6 , 10 , 11 ]) and high in three MAs (Linde 1998, Cucherat, Shang [ 7 – 9 ]) (Table (Table10). 10 ). ROBIS assessments of each MA with our comments on individual items are presented in Additional file 1 .
Risk of bias of meta-analyses: ROBIS assessments of individual items, domains and overall risk
Domains, signalling questions | Linde (1997) [ ] | Linde (1998) [ ] | Cucherat (2000) [ ] | Shang (2005) [ ] | Mathie (2014) [ ] | Mathie (2017) [ ] |
---|---|---|---|---|---|---|
1.1 Did the review adhere to predefined objectives and eligibility criteria? (protocol) | Probably Yes | Probably No | Probably Yes | Probably No | Yes | Yes |
1.2 Were the eligibility criteria appropriate for the review question? | Probably Yes | Probably No | Probably No | Probably Yes | Yes | Yes |
1.3 Were eligibility criteria unambiguous? | Probably Yes | Probably Yes | Yes | No | Yes | Yes |
1.4 Were all restrictions in eligibility criteria based on study characteristics appropriate? | Yes | Yes | Probably No | No | Yes | Yes |
1.5 Were any restrictions in eligibility criteria based on sources of information appropriate? | Yes | Yes | Yes | Yes | Probably Yes | Probably Yes |
1.6 Concerns? (low / high / unclear) | Low | High | High | High | Low | Low |
2.1 Did the search include an appropriate range of databases/electronic sources for published and unpublished reports? | Yes | Probably Yes | Yes | Yes | Yes | Yes |
2.2 Were methods additional to database searching used to identify relevant reports? | Yes | Yes | Yes | Yes | Yes | Yes |
2.3 Were the terms and structure of the search strategy likely to retrieve as many eligible studies as possible? | Probably No | Probably Yes | No Information | Probably No | Yes | Probably Yes |
2.4 Were restrictions based on date, publication format, or language appropriate? | Yes | Yes | Yes | Yes | Yes | Yes |
2.5 Were efforts made to minimise error in selection of studies? | Yes | No | Probably No | Probably No | Probably No | Probably No |
2.6 Concerns? (low / high / unclear) | Unclear | High | Unclear | High | Low | Low |
3.1 Were efforts made to minimise error in data collection? | Yes | No | Yes | Yes | Yes | Yes |
3.2 Were sufficient study characteristics available for both review authors and readers to be able to interpret the results? | Yes | Yes | Probably Yes | No | Yes | Yes |
3.3 Were all relevant study results collected for use in the synthesis? | Yes | Yes | Yes | Yes | Yes | Yes |
3.4 Was risk of bias (or methodological quality) formally assessed using appropriate criteria? | Probably Yes | Probably Yes | Probably Yes | Probably Yes | Yes | Yes |
3.5 Were efforts made to minimise error in risk of bias assessment? | Yes | No | Probably No | Probably No | Probably Yes | Probably Yes |
3.6 Concerns? (low / high / unclear) | Low | Unclear | Unclear | High | Low | Low |
4.1 Did the synthesis include all studies that it should? | Yes | Probably Yes | Probably Yes | No | Yes | Probably Yes |
4.2 Were all predefined analyses reported or departures explained? | Probably Yes | Probably No | Probably Yes | No | Probably Yes | Yes |
4.3 Was the synthesis appropriate, given the nature and similarity in the research questions, study designs, and outcomes across included studies? | Yes | Probably No | Probably Yes | No | Yes | Yes |
4.4 Was between-study variation (heterogeneity) minimal or addressed in the synthesis? | Yes | No | Yes | Probably Yes | Yes | Yes |
4.5 Were the findings robust, for example, as demonstrated through funnel plot or sensitivity analyses? | Yes | No | Probably Yes | No Information | Yes | No |
4.6 Were biases in primary studies minimal or addressed in the synthesis? | Yes | Yes | Probably No | No | Yes | Yes |
Concerns? (low / high / unclear) | Low | High | Unclear | High | Low | Low |
A. Did the interpretation of findings address all of the concerns identified in Domains 1 to 4? | Yes | Probably No | Probably Yes | No | Yes | Yes |
B. Was the relevance of identified studies to the review's research question appropriately considered? | Yes | Yes | Probably No | Probably No | Yes | Probably Yes |
C. Did the reviewers avoid emphasising results on the basis of their statistical significance? | Yes | Yes | Yes | No | Yes | Yes |
Risk of bias in the review (low / high / unclear) | Low | High | High | High | Low | Low |
AMSTAR [ 14 ] items 7 (list of excluded studies), 10 (funding sources for included studies) and 16 (conflict of interest of review authors) received the poorest ratings possible (0) for the first three MAs (Linde 1997 & 1998, Cucherat [ 6 – 8 ]) and the best ratings possible (1 or 2) in the most recent MAs (Mathie 2014 [ 10 ] and 2017 [ 11 ]). The MA conducted by Shang [ 9 ] had two ‘0’ ratings and one ‘1’ (0–2 possible) (Table (Table11 11 ).
Risk of bias of meta-analyses: AMSTAR items 7, 10, 16
Domain | Linde (1997) [ ] | Linde (1998) [ ] | Cucherat (2000) [ ] | Shang (2005) [ ] | Mathie (2014) [ ] | Mathie (2017) [ ] |
---|---|---|---|---|---|---|
7. Did the review authors provide a list of excluded studies and justify the exclusions? 0: No, 1: Partial Yes (provided a list of all potentially relevant studies that were read in full-text form but excluded from the review). 2 = Yes (1 + justified the exclusion from the review of each potentially relevant study) | 0 | 0 | 0 | 0 | 2 | 2 |
10. Did the review authors report on the sources of funding for the studies included in the review? 0: No. 1: Yes, they reported on the sources of funding for individual studies included in the review OR the reviewers looked for this information but it was not reported by study authors | 0 | 0 | 0 | 0 | 1 | 1 |
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? 0: No. 1: The authors reported no competing interests. 2: The authors described their funding sources and how they managed potential conflicts of interest | 0 | 0 | 0 | 1 | 2 | 2 |
All trials with extractable data for meta-analysis.
Effect estimates—or for the MA conducted by Cucherat [ 8 ]: combined p values—for all trials with extractable data were reported in five MAs (not from Shang [ 9 ]). All analyses showed a significant positive effect of homoeopathy compared to placebo (Table (Table12 12 ).
Primary outcomes of systematic review: effect estimates for all trials and for high-quality trials
Meta-analysis | trials | quality components | Effect size | Favours homoeopathy | Significant? | ||
---|---|---|---|---|---|---|---|
Statistic | Metric | Estimate (95% confidence intervaI) | |||||
Linde (1997) [ ] | 89 | 0 | Random effects | OR | 2.45 (2.05–2.93) | > 1 | Yes |
Linde (1998) [ ] | 18 | 0 | Fixed effects | RR | 1.66 (1.20–2.28) | > 1 | Yes |
Linde (1998) [ ] | 18 | 0 | Fixed effects | OR | 2.62 | > 1 | Yes |
Cucherat (2000) [ ] | 17 | 0 | Not applicable | = 0.000036 | NA | Yes | |
Mathie (2014) [ ] | 22 | 0 | Random effects | OR | 1.53 (1.22–1.91) | > 1 | Yes |
Mathie (2017) [ ] | 54 | 0 | Random effects | SMD | 0.33 (0.21–0.44) | > 0 | Yes |
Linde (1997) [ ] | 26 | 7 | Random effects | OR | 1.66 (1.33–2.08) | > 1 | Yes |
Linde (1997 and 1999) [ , ] | 26 | 7 | Meta regression | OR | 1.72 (1.28–2.31) | > 1 | Yes |
Shang (2005)/Lüdtke (2008) [ ] | 21 | 3 | Random effects | OR | 0.76 (0.59–0.99) | < 1 | Yes |
Mathie (2014) [ ] | 3 | 7 | Random effects | OR | 1.98 (1.16–3.38) | > 1 | Yes |
Mathie (2017) [ ] | 3 | 7 | Random effects | SMD | 0.18 (− 0.09 to + 0.46) | > 0 | No |
OR odds ratio, RR rate ratio, SMD standardised mean difference
a Cucherat [ 8 ]: 17 comparisons from 16 trials
b An eligibility criterion for Cucherat [ 8 ] was ‘trials with [one] clearly defined primary outcome’, which corresponds to a quality component applied in other MA
c An eligibility criterion for Mathie (2014 and 2017) was ‘publication format: peer-reviewed journal article of at least 500 words
Effect estimates for high-quality trials Data items / Primary outcome were available for four MAs (not for the MAs conducted by Linde (1998) [ 7 ] and Cucherat [ 8 ]). Three MAs (Linde 1997, Shang/Lüdtke, Mathie 2014 [ 6 , 9 , 10 , 32 ]) showed a significant positive effect of homoeopathy compared to placebo, and one MA (Mathie 2017) [ 11 ] showed no significant difference between homoeopathy and placebo (Table (Table12 12 ).
Sensitivity analyses: sample restriction to trials fulfilling quality criteria.
Sample restriction to trials fulfilling 1 quality criterion
Sensitivity analyses with sample restriction to trials fulfilling 1 quality criterion were reported in four MAs [ 6 , 7 , 10 , 11 ], with a total of 12 analyses based on 7 different single quality components (‘explicitly randomised’, ‘adequate concealment of random allocation’, ‘double-blinding stated’, ‘follow-up adequate/complete’, ‘main outcome predefined’, ‘Medline-listed’, ‘free of [funding-related] vested interest’). Of the 12 analyses, 11 showed a significant positive effect of homoeopathy compared to placebo (Suppl. Table 28 ).
Sample restriction regarding 2–4 quality components
Sensitivity analyses with sample restriction regarding 2–4 quality components were reported in 3 MAs. In the MA conducted by Linde (1997) [ 6 ], trials with a Jadad score > 2 had a significant positive effect of homoeopathy. In the MA conducted by Linde (1998) [ 7 ], the effect estimate for trials fulfilling 3 criteria (Medline-indexed + double-blind + “no other obvious relevant flaws”) did not differ significantly from placebo. In the MA conducted by Shang [ 9 ] and analysed by Lüdtke [ 32 ], the effect estimates for high-quality trials (interpreted as based on 3 components) fulfilling one additional criterion (Medline-listed, English language, Intention-to-treat principle, respectively) analysed with random-effects or meta-regression did not differ significantly from placebo (Suppl. Table 29 ).
Sample restriction regarding ≥ 5 quality components
Sensitivity analyses with sample restriction regarding 5 or more quality components were reported in 3 MAs with one analysis each. In the MA conducted by Linde (1997) [ 6 ], trials with an internal validity score > 4.5 ( n = 7 components) had a significant positive effect of homoeopathy. In the MAs conducted by Mathie (2014 and 2017) [ 10 , 11 ], high-quality trials and A- and B-rated trials (trials rated as having low or uncertain risk of bias in all seven domains of Cochrane RoB), respectively, both sets in addition rated as free from publication-rated vested interests ( n = 8 components each) showed no significant effect differences between homoeopathy and placebo (Suppl. Table 29 ).
Cumulative MA with stepwise removal of trials by risk-of-bias ratings
Cumulative MA with stepwise removal of trials by risk-of-bias ratings was performed in four MAs, including three (Linde 1997/1999, Mathie 2014 and 2017 [ 6 , 7 , 10 , 11 ]) using incremental removal according to interval-scaled instruments and one (Cucherat [ 8 ]) using a rank-ordered scale. The scales used by Linde (1997/1999 [ 6 , 30 ]) were additive (sum of score points), while the remaining scales were in part [ 10 , 11 ] or fully [ 8 ] hierarchically constructed.
In the MA conducted by Linde (1997/1999) [ 6 , 30 ], two cumulative MAs were performed: (1) For the Jadad score (range 0–5, 5 points indicating highest possible quality), a significant positive effect of homoeopathy was retained with a score of 5 points ( n = 10 trials). For the internal validity score (range 1–7, 7.0 points indicating highest possible quality), significant positive effects of homoeopathy were retained up to 6.5 points ( n = 7 trials), while no significant difference was observed for 7.0 points ( n = 5 trials) (Suppl. Table 31 ).
In the MA conducted by Cucherat [ 8 ], a cumulative MA was performed using a rank-ordered scale, with step 4 indicating the highest possible quality assessed by the authors. Significant positive effects of homoeopathy were retained up to step 3 (double-blind + dropout rate < 10%, n = 9 trials), while no significant difference was observed at step 4 (double-blind + dropout rate < 5%, n = 5 trials) (Suppl. Table 33 ).
In the MAs conducted by Mathie (2013/2014 [ 10 , 28 ] and Mathie (2017) [ 11 ]), one cumulative MA was performed based on the Cochrane RoB tool (2011 version), with 7 items for which the risk of bias was rated as low (A), uncertain (B) or high (C). Trials with 7 × A were rated A, trials with 7x (A or B) were rated as B and trials with ≥ 1 × C were rated as C. In addition to this hierarchical classification, Mathie counted the number of A- and B-rated items for each trial, allowing for a more differentiated assessment.
Statistical adjustment for possible publication bias or other small trial effects
Statistical adjustment for possible publication bias or small trial bias—without any additional sensitivity analysis—was performed for two MAs (Linde 1997, Mathie 2017 [ 6 , 11 ]). In both cases, a significant positive effect of homoeopathy was retained after adjustment (Suppl. Table 34 ).
Sensitivity analyses with sample restriction to trials with a higher sample size
Sample restriction to trials with a higher sample size—without any additional sensitivity analysis—was performed for two MAs (Mathie 2014 and 2017) [ 10 , 11 ]. In both cases, the sample was restricted to trials with a sample size above the median, and in both cases, a significant positive effect of homoeopathy was retained (Suppl. Table 30 ).
Sample restriction regarding methodological quality + restriction to trials with a higher sample size was performed in two MAs (Shang [ 9 ]: high-quality trials + “large” trials; Mathie (2017) [ 11 ]: A- and B-rated trials + sample size above the median for all trials). In both cases, no significant difference between homoeopathy and placebo was observed (Suppl. Table 35 ).
Lüdtke [ 32 ] performed a cumulative analysis, varying the cut-off point for ‘large trials’ among the 21 high-quality trials included in the MA conducted by Shang [ 9 ]: a significant effect of homoeopathy compared to placebo was observed with a sample restriction to the 20, 19, 18, 16, 15 and 14 largest trials, respectively, while no significant difference was found with a sample restriction to the 17, 13 and 1–12 largest trials, respectively [ 32 ].
In the MA conducted by Shang [ 9 ], meta-regression analyses of ‘predicted effect in trials as large as the largest trials included in the study’ (without further specification; we assume the authors meant the intercept from the regression of odds ratios on the standard error) showed no significant difference between homoeopathy and placebo (Additional file 2 ).
Subgroup interactions were analysed in 3 MAs (Shang, Mathie 2014 and 2017 [ 9 – 11 ]). No significant associations were found for duration of follow-up, indication type (acute/chronic/prophylaxis) or type of homoeopathy (4 groups) (Suppl. Table 36 ).
Effect estimates were analysed in a total of 23 subgroups, pertaining to indication (acute or chronic), type of homoeopathy ( n = 10 subgroups), homoeopathic potency ( n = 6) and outcome metric in trials ( n = 5) (Suppl. Table 37 ). Of these 23 analyses, 21 showed a significant positive effect of homoeopathy, while two showed no significant difference from placebo: potencies < 12C in the MA conducted by Mathie (2014) [ 10 ], which was restricted to I-HOM; homoeopathic combination products in the MA conducted by Mathie (2017) [ 11 ] (a category only described and evaluated in this MA, cf. Suppl. Table 10 ). No subgroup analyses were performed on patient age groups.
Neither statistical homogeneity/heterogeneity nor funnel plot inspection with related statistical tests were reported in any subgroup as defined in Section ' Methods / Subgroup analyses '. However, withstanding that Mathie (2014) [ 10 ] and Mathie (2017) [ 11 ] were part of one MA programme, these two MAs can be considered subgroup analyses pertaining to the type of homoeopathy. For I-HOM (Mathie 2014 [ 10 ], n = 22 trials), neither heterogeneity nor FPA was found. For NI-HOM (Mathie 2017 [ 11 ], n = 54 trials), significant heterogeneity as well as FPA were found (cf. Section ' Assessments of bias and heterogeneity ', above).
Of the 23 subgroup analyses, 15 were specified in a prepublished protocol (Mathie 2014 and 2017 [ 10 , 11 ]), while 8 analyses—albeit from MAs based on predefined protocols—were not explicitly stated to be prespecified (Linde 1997 [ 6 ], Cucherat 2000 [ 8 ]). Of the 15 former analyses, 14 showed a significant positive effect of homoeopathy, while 1 did not (Mathie 2014 [ 10 ], see above).
Data for the comparison of MAs of placebo-controlled trials of homoeopathic and conventional treatment in Shang [ 9 ] are presented in Additional file 2 .
After literature searches and data collection for this SR had been completed, an additional subgroup analysis of the MA conducted by Mathie (2017) [ 11 ] was published, which we decided to include, as it concerned an item that had not been analysed for any of the MAs: trial registration (Gartlehner 2022) [ 34 ]).
The 54 trials included in the MA conducted by Mathie (2017) [ 11 ] were published in the period from 1976 to 2014, and 20 of those trials were published from 2002 to 2014. Of this group, Gartlehner et al. analysed 19 trials, stratified according to clinical trial registration, which had been available at ClinicalTrials.gov since 2000. A random effects MA showed a positive significant effect of homoeopathy compared to placebo in n = 6 registered trials (SMD 0.53, 95% CI 0.20–0.87) and no significant difference from placebo in n = 13 unregistered trials (SMD 0.14, 95% CI − 0.07 to + 0.35). However, the between-group difference in effect estimates was not significant (meta-regression: SMD 0.39, 95% CI − 0.09 to + 0.87) [ 34 ]. It is not clear why trial #A93 of the MA conducted by Mathie (2017 [ 11 ], Lewith 2002, listed in Gartlehner [ 34 ], Supplement Table Table3 3 as ‘not registered’) was not included in these analyses.
The proportion of registered trials was 100% ( n = 3/3) among high-quality trials and 19% ( n = 3/16) among the other trials (Suppl. Table 38 ).
The assessment of confidence in cumulative evidence for research questions 1 and 2 (cf. Section ' Research questions ', above) according to the GRADE framework (cf. Section ' Confidence in cumulative evidence/Certainty assessment ') is presented in Additional file 3 . Conclusions are summarised in the following Sections:
The quality of evidence (high/moderate/low/very low) for significant positive effects of homoeopathy beyond placebo is moderate for ALL-HOM and NI-HOM and high for I-HOM.
If the data sources were restricted to MAs with a low risk of bias [ 6 , 10 , 11 ], the quality of evidence would be changed to high for ALL-HOM and remain high for I-HOM and moderate for NI-HOM.
The available data yield no support for the alternative hypothesis of no outcome difference between homoeopathy and placebo.
Different types of homoeopathic treatment.
The notion of a common positive effect is
As the MA of NI-HOM (Mathie 2017 [ 11 ]) comprised different indications treated with different homoeopathic products, the latter finding suggests that the effects of NI-HOM may differ across different indications and/or different homoeopathic products used. Such effect differences may include significant positive effects of NI-HOM as well as no significant difference between NI-HOM and placebo in different subgroups.
The limited data available support the notion of a common positive effect of homoeopathy for acute as well as chronic indications. The issue of effect differences among different diagnoses or diagnosis groups is outside the scope of this SR.
In this first SR of MAs of placebo-controlled randomised trials of homoeopathy for any disorder in humans, homoeopathy had a significant positive effect compared to placebo for all eligible trials in 5 of 5 evaluable MAs and for high-quality trials in 3 of 4 MAs. Assessed by the GRADE system, the quality of evidence for positive effects (high/moderate/low/very low) was high for I-HOM and moderate for ALL-HOM as well as for NI-HOM. There was no support for the alternative hypothesis of no outcome difference between homoeopathy and placebo.
This systematic review as such.
The strengths of this SR include a detailed, prepublished PRISMA-P [ 12 ] -compliant protocol with two focused research questions, comprehensive presentation of findings, the use of well-established assessment instruments (ROBIS [ 13 ], GRADE [ 20 ]) and adherence to standard reporting guidelines (PRISMA 2020 [ 27 ]).
The scope of this review had two clear limitations: it was restricted to efficacy in placebo-controlled trials and did not address results for specific indications or indication groups.
We used the GRADE system to assess confidence in the cumulative evidence and found it very helpful. Nonetheless, there are three relevant differences between the GRADE approach and this SR: (1) The GRADE approach is indication- and outcome-specific, while we studied MAs with effect estimates for trials with different indications and outcomes. (2) The GRADE framework is tailored to comparative effectiveness, while we assessed MAs of placebo-controlled trials. (3) The GRADE assessment of confidence in cumulative evidence refers to the magnitude of effects, while our research question concerned the existence of significant effects of homoeopathy beyond placebo (yes/no). Accordingly, our conclusions on confidence in the cumulative evidence may not be directly comparable to those of other SRs in the same research field.
According to the ROBIS framework, the risk of bias of the six included MAs was rated as low for Linde (1997) [ 6 ], Mathie (2014 [ 10 ]) and Mathie (2017 [ 11 ]) and high for Linde (1998) [ 7 ], Cucherat [ 8 ] and Shang [ 9 ].
The evidence generated in this SR is based on 6 MAs, of which the risk of bias was rated as low for 3 and high for 3. If the data were restricted to the 3 MAs with a low risk of bias, the quality of evidence would be rated high for ALL-HOM and I-HOM and moderate for NI-HOM (Additional file 3 ).
Compared with trials of nonhomoeopathic interventions, which were assessed with identical rating instruments, the methodological quality of the homoeopathy trials in the MAs of this SR was similar for the MAs conducted by Mathie (2014 and 2017 [ 10 , 11 ]) and higher for the MA conducted by Shang [ 9 ]. Significant associations between methodological quality and effect estimates were found in 12 of 24 analyses. After restricting the sample to high-quality trials according to predefined criteria, effect estimates were reduced [ 6 , 11 ] or increased [ 10 ], with 3 of 4 MAs showing significant effects of homoeopathy compared to placebo. When adding a 5 th MA (Cucherat [ 8 ]) to the assessment and applying the same high-quality criteria as in the 3-component model of Shang [ 9 ], 4 of 5 MAs showed significant benefit of homoeopathy.
As assessed by the GRADE system, the quality of evidence for positive effects (high/moderate/low/very low) was high for I-HOM and moderate for NI-HOM and ALL-HOM. In comparison, among 608 Cochrane reviews published from January 2013 to June 2014, the GRADE-assessed quality of evidence for the primary outcome was high in only 13% of reviews, moderate in 31%, low in 32% and very low in 24% [ 44 ]. In a randomised sample of Cochrane reviews up until 2021, 90% of 1567 GRADE-assessed interventions were not supported by evidence of high quality [ 45 ].
This SR had two limitations. (1) As this was a SR of MAs rather than of individual trials, the trials examined herein were limited to those included in the MAs. Thus, eligible trials published after 2011 and 2014 for I-HOM and NI-HOM, respectively, could not be included. (2) Differential effects of homoeopathy on different indications and patient groups were only assessed for acute and chronic indications and for adults and children, with very limited data available.
According to this SR, homoeopathy can have positive effects beyond placebo on disease in humans. This is in accordance with laboratory experiments showing partially replicable effects of homoeopathically potentised preparations in physico-chemical [ 46 ], in vitro [ 47 ], plant-based [ 48 , 49 ] and animal-based [ 50 – 52 ] test systems.
In contrast to frequent claims, the available MAs of homoeopathy in placebo-controlled randomised trials for any indication show significant positive effects beyond placebo. Compared to other medical interventions, the quality of evidence for efficacy of homoeopathy was similar or higher than for 90% of interventions across medicine [ 45 ]. Accordingly, the efficacy evidence from placebo-controlled randomised trials provides no justification for regulatory or political actions against homoeopathy in health-care systems.
For I-HOM, an update of the MA conducted by Mathie (2014 [ 10 ]) would be warranted to reassess efficacy evidence after inclusion of trials published after 2011. For NI-HOM, the results of the MA conducted by Mathie (2017 [ 11 ]) with 54 trials were heterogeneous. Accordingly, future research on the efficacy of NI-HOM should focus on specific nonindividualised forms of homoeopathic therapy or specific interventions therein for specific indications. Recommendations for comparative effectiveness research on homoeopathy are beyond the scope of this review.
We thank Gunver S. Kienle (GSK) for the assistance with data extraction and assessment of risk of bias of the MAs.
HJH: Literature search and screening, assessment of literature records for inclusion, data collection, assessment of risk of bias of MA, manuscript drafting and revision. AG: Literature search and screening, assessment of literature records for inclusion, data collection, coding of indications, additional analyses, manuscript drafting and revision. KvA: Manuscript drafting and revision. DSR: Manuscript drafting and revision. HK: Data collection, manuscript drafting and revision. All authors of the manuscript have read and agreed to its content and are accountable for all aspects of the accuracy and integrity of the manuscript in accordance with ICMJE criteria. All authors have approved the manuscript for submission.
Open Access funding enabled and organized by Projekt DEAL. Funding specifically for this SR was provided by Christophorus-Stiftung (No. 393 CST), Stiftung Marion Meyenburg (Date 24.09.2020), Dr. Hauschka Stiftung (Date 16.11.2020) and Gesellschaft für Pluralität im Gesundheitswesen (Dates 11.06.2021, 22.06.2021). General funding for IFAEMM was provided by the Software-AG Stiftung (SE-P 13544). The funders had no influence on the writing of the protocol or on the planning, conduct and publication of this SR.
Declarations.
Not applicable, as this SR does not involve any original research on humans.
In the past 3 years, HJH has received research grants from two manufacturers of anthroposophic medicinal products (Wala Heilmittel GmbH, Bad Boll/Eckwälden, Germany; Weleda AG, Arlesheim Switzerland). Anthroposophic medicine is not based on the homoeopathic simile principle or on drug provings, but some anthroposophic medicinal products are potentized. The two manufacturers had no involvement with the present SR. Anthroposophic medicinal products were not part of the intervention in any of the trials evaluated in the MAs of this SR (Suppl. Table 15 ). DSR has received a development grant from Heel GmbH (manufacturer of homoeopathic products) for online training in case report writing. AG, KvA and HK declare that they have no competing interests.
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Title: | Effectiveness of Homeopathic Medicines in Acute Sinusitis in Children Dissertation |
Researcher: | T ANIL KUMAR |
Guide(s): | |
Keywords: | Clinical Medicine Clinical Pre Clinical and Health Medicine General and Internal |
University: | Babasaheb Bhimrao Ambedkar Bihar University |
Completed Date: | 2009 |
Abstract: | newline |
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URI: | |
Appears in Departments: | |
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Indian journal of research in homoeopathy follow.
Print ISSN: 0974-7168 E-ISSN: 2320-7094
Indian Journal of Research in Homoeopathy , a publication of Central Council For Research In Homoeopathy, is a peer-reviewed online journal.
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Ayush(ayurveda, yoga & naturopathy, unani, siddha and homoeopathy).
DEPARTMENT OF HOMOEOPATHIC PHARMACY
About: The Department of Homoeopathic pharmacy conducts regular classes for the BHMS students as well as MD(Hom) students as per the syllabus and curriculum of Central Council of Homoeopathy (www.cchindia.com), New Delhi and the courses are affiliated to the West Bengal University of Health Sciences (www.wbuhs.org). The PG division has an admission capacity of three Post Graduate Trainees per year.
Activities: The students are exposed to different methods of preparing homoeopathic medicines and the method of their standardization as per the CCH syllabus. Apart from theoretical and practical training in the subject of Homoeopathic Pharmacy periodical assessment tests and tutorials are conducted to equip the students for their 1 st BHMS examination under the West Bengal University of Health Sciences.
The well-equipped laboratory can accommodate 50 students at a time to cater the need of increased number of students at UG level. The laboratory is well equipped with modern pharmaceutical appliances like Electrical Potentisers, Electric Triturating machines, Spectrophotometer, distillation plant, hot air oven, water bath, microscope, infrared moisture balance apart from other common instruments.. The laboratory also contains 51 herbarium sheets in wooden frame, 146 herb specimen (dry), 36 herb specimens (preserved in FAA solution), 10 mineral specimens and 9 animal specimens and 10 botanical slides.
Department is having 30 nos. of charts on Pharmacy & also enough chemicals for conducting practical classes. Departmental Library has books in the subjects like BHP, USHP, and HPI along with other reference books on medicinal plants and CD’s on pharmacy.
The department has a small medicinal plants garden in the institute campus. The students of 25 th batch were taken to “Hapco” Manufacturing unit at Titagarh (W.B) and kalyani Herb Garden (under NIH) on 13.11.2014. The result of the University examination of 24 th Batch & supplementary batch BHMS students is being given below.
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24 Session-2012-14 | 1 BHMS Exam 2014 | 87 | 65 |
24 (Supplementary) | 1 BHMS Exam 2014 | 22 | 15 |
25 Session 2013-14 | Ist BHMS Exam | 04 | 04 |
25 Session 2013-14 (Supplimentary) | 1 BHMS Exam | 85(exam going on) | - |
The department conducts PG course in Homoeopathic Pharmacy i.e., M.D.(Hom.) with three admissions each academic year. There is a separate air conditioned Post Graduate Laboratory where the PG trainees can do their thesis work and practicals. This lab has Electric Potentiser, Electric Triturator, Spectroscope, TLC apparatus, Colorimetry apparatus, digital balance, digital pH meter along with glass wares and chemicals. Currently there are three Post Graduate batches in roll. three in 2012-15 (14 th batch), three in 2013-16 (15 th batch) and two (16 th Batch) PG students got themselves admitted in session 2014-17. The 13 th batch has appeared for their final Part II exam during April-May 2015 and all of them passed out. The present status is given below:
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13 batch | 03 | Appeared in October 2013 | Appeared in April/May 2015 | Part I and Part II All passed (100%) |
14 batch | 03 | Appeared in July/August 2014 | - | Part I All passed (100%) |
15 batch | 03 | Appeared in July 2015 | - | Part I All passed |
16 batch | 02 | - | - | First year continuing |
Dissertation of PG:
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12 | 2010-13 | DR DILIP PANAKKADA | Dr SANTANU GHOSH | Discontinued the course |
12 | 2010-13 | Dr PARTHA CHAKRABORTY | Discontinued the course | |
13 | 2011-14 | Dr PRASANJIT KUMAR DEY | RANDOMIZED CONTROLLED TRIAL ON THE EFFECT OF PAEONIA OFFICINALIS 6C IN HAEMORRHOIDS | |
13 | 2011-14 | Dr DIBYENDU MONDAL | RANDOMIZED CONTROLLED TRIAL ON THE EFFECT OF HOMOEOPATHIC PREPARATIONS OF BAPTISIA TINCTORIA AGAINST IN VITRO SAMPLES OF SALMONELLA TYPY, ESCHERISHIA COLI BY USING CYLINDER PLATE METHOD OF CULTURE SENSITIVITY TEST. | |
13 | 2011-14 | Dr VARINDER KAUR ROY | RANDOMIZED CONTROLLED TRIAL ON THE EFFECT OF COLCHICUM AUT 6C ON HIGH SERUM URIC ACID LEVEL. | |
14 | 2012-15 | Dr SANGITA RANI DINDA | STUDY ON THE PHYTOCHEMISTRY OF HOM. MEDICINES NAMELY JONOSIA ASHOKA, CALOTROPIS GIGANTEA AND AZADIRACHGTA INDICA IN MOTHER TINCTURES AND LOWER POTENCIES | |
14 | 2012-15 | Dr PUSPAJIT MURMU | COMPARATIVE STUDY OF THE PHARMACOPOEIAL STANDARDS OF ABROMA AUGUSTA MOTHER TINCTURE PREPARED BY CLASSICAL HAHNEMANNIAN METHOD AND NEW METHOD AS WELL AS TO STUDY THE RELATIVE CLINICAL EFFICACY OF ITS 6C POTENCY DERIVED BY ABOVE TWO METHODS IN DIABETIS MELLITUS TYPE-II | |
14 | 2012-15 | Dr DEWESH KUMAR DEWANSHU | RELATIVE EFFICACY OIF QUERCUS GLANDIUM SPIRITUS IN MOTHER TINCTURE AND ITS 6TH POTENCY IN TREATMENT OF ALCOHOLIC LIVER DISEASE | |
15 | 2013-16 | Dr MRINMOY NASKAR | STUDY TO VERIFY THE EFFECT OF HOMOEOPATHIC PREPARATIONS OF CALCAREA CARBONICA IN HYPOTHYROIDISM | |
15 | 2013-16 | Dr JAVED AQUTAR BAPPA | CLINICAL STUDY ON THE EFFECTS OF TOPICAL APPLICATION OF CHRYSAROBINUM OINTMENT IN 1:9, 1:19 AND 1:29 RATIO IN PITYRIASIS VERSICOLOR | |
15 | 2013-16 | Dr MITRAJIT KOLEY | RANDOMIZED CONTROLLED TRIAL ON THE EFFECT OF LACHESIS 30C IN ESSENTIAL HYPERTENSION | |
16 | 2014-17 | Dr BUDHADEB CHAKRABORTY | YET TO SUBMIT SYNOPSIS | |
16 | 2014-17 | Dr AYESHA NAAZ | YET TO SUBMIT SYNOPSIS |
Faculty members with qualification:
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1 | Dr. Dilip Panakkada | B.Sc, BHMS, MD(Hom) PG Dip EDP & CM | Professor and Head |
2 | Dr. Gitasri Pal | BHMS(Hons), MD(Hom) | Reader |
3 | Dr. M. Raja | BHMS, MD(Hom) | Lecturer |
6. Key person to contact:
Dr Dilip Panakkada, Professor & Head of Department.
Phone No: 09433182784
E-mail: [email protected]
Our editors will review what you’ve submitted and determine whether to revise the article.
Mytishchi , city, centre of a rayon (sector), Moscow oblast (region), western Russia , situated northeast of the city of Moscow. Mytishchi’s importance in the past derived from its position on the road between Moscow and the Trinity–St. Sergius Monastery. It was the source of Moscow’s water supply until the 20th century. In 1908 Mytishchi became the site of the first artificial-fibre factory in Russia. Since its incorporation in 1925, the city has become a centre of machine building, especially transport machinery. Pop. (2006 est.) 161,811.
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1.Introduction: Schizophrenia is a serious mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality ...
Research topics for PG Scholars of homoeopathic pharmacy Dr. R. Valavan, BHMS, MD (Hom. Pharm.), MBA. I am often asked to suggest some topics for PG Scholars of homoeopathic pharmacy. Here I make an attempt to list them out. Topics are bifurcated as follows: The ones which could be done within the institute with or without little aid from outside.
An exhaustive list of topics for MD, post-graduation, and PhD thesis topics. The Next Step This work is an ongoing process, where readers are invited to comment, criticize and contribute.
The main outcome analysis showed a significant positive effect of homoeopathy compared to placebo in 14-65% (weighted mean 36.5% (n = 113 of 310 trials), a nonsignificant superiority of homoeopathy in 18-55% (weighted mean 44.2%), a nonsignificant superiority of placebo in 16-32% (mean 19.0%) and a significant positive effect of placebo ...
PG Scholar MD(HOM), Department of Homoeopathic Pharmacy Government Homoeopathic Medical College and Hospital, Bhopal, Madhya Pradesh, India. Abstract: The distinctiveness of Homoeopathic Pharmacology is based on the Theory of Drug Dynamization (Potentization). Hahnemann integrated Pharmacodynamic by proving the drug on healthy individuals and ...
Consult the top 50 dissertations / theses for your research on the topic 'Homeopathy - Materia medica and therapeutics.'. Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA ...
The document discusses the challenges of writing a dissertation on the niche topic of homeopathy. It acknowledges that crafting a dissertation requires extensive research, analyzing complex ideas, and maintaining academic rigor. Writing on alternative medicine topics like homeopathy intensifies these challenges due to needing deep subject matter expertise. The document then promotes a ...
Consult the top 50 dissertations / theses for your research on the topic 'Homoeopathy.' Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
Effectiveness of Homeopathic Medicines in Acute Sinusitis in Children Dissertation: Researcher: T ANIL KUMAR: Guide(s): AJAY SINGH PARIHAR: Keywords: Clinical Medicine Clinical Pre Clinical and Health Medicine General and Internal: University: Babasaheb Bhimrao Ambedkar Bihar University: Completed Date: 2009: Abstract: newline: Pagination: URI:
Homeopathic Thesis Topics - Free download as PDF File (.pdf), Text File (.txt) or read online for free. The document discusses the challenges of writing a thesis on homeopathic topics and recommends seeking assistance from HelpWriting.net. It notes that homeopathic thesis topics require integrating both conventional medical science and alternative healing methods.
List of dissertations / theses on the topic 'Homoeopathic'. Scholarly publications with full text pdf download. Related research topic ideas.
Research and Homoeopathy. Abstract: The high quality of medical care we enjoy today is built upon years of effort by medical personalities. Homoeopathy is a controversial topic in complementary medicine research. Objective: To highlight the present status of research in homoeopathy. However, there is still much work to be done.
Print ISSN: 0974-7168. E-ISSN: 2320-7094. Indian Journal of Research in Homoeopathy, a publication of Central Council For Research In Homoeopathy, is a peer-reviewed online journal. Visit the Indian Journal of Research in Homoeopathy journal homepage to see the latest issue.
athic Remedi. K. Aiyar at Psycho Press, Bombay Published by Dr. P. Sankaran for the Homoeopathic Medical Publish. ELEMENTS OF HOMOEOPATHIC PHARMACPharmacy is defined as that department of the medical art which consists in the collecting of drugsand the preparing, preser. ing, and dispensing of medicines.Drugs are substances which have the power ...
HOMOEOPATHIC PHARMACY . Print . ... Dissertation topic . 12. 2010-13. DR DILIP PANAKKADA. Dr SANTANU GHOSH. Discontinued the course . 12. 2010-13. Dr PARTHA CHAKRABORTY. Discontinued the course . 13. 2011-14. Dr PRASANJIT KUMAR DEY. RANDOMIZED CONTROLLED TRIAL ON THE EFFECT OF PAEONIA OFFICINALIS 6C IN HAEMORRHOIDS. 13.
Synopsis On Homoeopathic Management... Title: Homoeopathic Management of Polycystic Ovary Syndrome Induced Infertility by using the... Our Brands. Homeopathy360. BJain Books. The Homeopathic Heritage. Homeopathy Gurukul. Homeopathy 360. News.
Mytishchi, city, centre of a rayon (sector), Moscow oblast (region), western Russia, situated northeast of the city of Moscow.Mytishchi's importance in the past derived from its position on the road between Moscow and the Trinity-St. Sergius Monastery. It was the source of Moscow's water supply until the 20th century. In 1908 Mytishchi became the site of the first artificial-fibre ...
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