Trick or Treatment—The Undeniable Facts about Alternative Medicine (Electronic book text)

This interpretation becomes more convincing if we bear in mind another aspect of his research. While conducting his meta-analysis on homeopathy, he also conducted a meta-analysis for a whole variety of new, conventional pharmaceuticals. These pharmaceuticals had been tested on the same illnesses that had been considered for the homeopathy meta-analysis. In this secondary meta-analysis, Shang scrupulously applied exactly the same selection criteria to these conventional drug trials as he had done in his homeopathy meta-analysis. The result of his meta-analysis on conventional drug trials was that on average they worked. Although this result also had an uncertainty associated with it, the average benefit was so large that the effectiveness of these new conventional drugs was not in any doubt.

The contrast between the homeopathic trials and the conventional drug trials was striking. Homeopathy had failed to show a clear benefit for patients and the result was compatible with homeopathy acting as a placebo, whereas conventional drugs had shown a clear benefit for patients, which suggested that they do indeed have a genuine physiological impact on the body. This illustrates the stark difference between pseudo-medicine and real medicine.

Shang published his results in the Lancet in August 2005. Based on his meta-analysis, he concluded: ‘This finding is compatible with the notion that the clinical effects of homeopathy are placebo effects.’ Reinforcing this point, the Lancet ran an editorial entitled ‘The end of homeopathy’ in which they argued that ‘doctors need to be bold and honest with their patients about homeopathy’s lack of benefit’. This sparked major news stories around the world, angering homeopaths who refused to accept the conclusions of Shang’s meta-analysis and the Lancet’s accompanying statement. They attempted to undermine the research by pointing out four key issues, but in fact each of their criticisms can be easily addressed.

Homeopaths might argue that Shang’s paper indicates a positive effect for homeopathy, and that his meta-analysis therefore supports homeopathy.

There is indeed a positive effect for homeopathy, but it is very small and entirely compatible with the treatment being a placebo. Shang’s paper is the most comprehensive analysis of homeopathy during its 200-year history, and such a paucity of positive evidence has to be interpreted as a blow for homeopathy. Crucially, Shang’s analysis confirms the results of about a dozen other meta-analyses and systematic reviews published over the last decade, all of which fail to show that homeopathy offers any benefit beyond placebo.

Homeopaths claim that Shang dredged the data, which means that the meta-analysis was conducted in such a way as to bias the conclusion.

There are indeed many ways to conduct a meta-analysis. Therefore it is possible to ‘dredge the data’ in different ways until the most positive or negative result emerges, but importantly Shang had stated what his approach would be before embarking on the meta-analysis, and his approach seemed reasonable and unbiased. In other words, the research was impartial because the goalposts were decided before the data was examined, and the goalposts were of a fair size and were not moved once the research was under way.

Homeopaths point out that the meta-analysis included trials for several illnesses, which makes it too crude to say anything meaningful about homeopathy’s ability to treat individual conditions.

This over-arching meta-analysis was prompted by the fact that there has been no convincing evidence that homeopathy can treat any individual condition. Whenever researchers have conducted systematic reviews of homeopathy for a particular condition, the results have been consistently disappointing. For headaches and migraine: ‘The trial data available to date do not suggest that homeopathy is effective.’ For muscle soreness, the most tested condition: ‘The published evidence to date does not support the hypothesis that homoeopathic remedies used in these studies are more efficacious than placebo.’ For Arnica in the treatment of conditions associated with tissue trauma (e.g. post operative or post-dental), which is the most widely used homeopathic remedy: ‘The claim that homeopathic Arnica is efficacious beyond placebo is not supported by rigorous clinical trials.’

Homeopaths point out that they offer a highly individualized treatment, which is not suited to large-scale trials in which the homeopathic remedy is standardized.