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"In the comments to a post at Respectful Insolence, my favourite homeopath Dana Ullman weighs in with the suggestion that the Shang et al. meta-analysis of trials of homeopathy and conventional medicine (which has been written about extensively by me and apgaylard), had been "blown out of the water". Ullman makes this assertion based on a new paper by Ludtke and Rutten, entitled "The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials", that has been accepted by the Journal of Clinical Epidemiology. It's nice to see that this paper does exist after all. So does the article really blow Shang out of the water? A quick look at the conclusions tells us that the answer is no…the upshot is that the paper's title is misleading. The conclusions on the effectiveness of homeopathy do not highly depend on the set of analyzed trials, if an appropriate test is used. Asymmetry is not adequately identified in the dataset because too few trials are used. And, even if you can convince yourself that you can get a statistically significant benefit by playing around with the numbers, the actual clinical benefit is negligible. In some ways, the paper actually reinforces the conclusions of Shang et al., and it certainly doesn't show that homeopathic medicines work. Paul Wilson, Hawk-Handsaw blogspot (8th October 2008)
Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy; Aijing Shang, Karin Hawiler-Muntener, Linda Nartey, Peter Juni, Stephan Dorig, Jonathan A. C. Sterne, Daniel Pewsner, Matthias Egger; Lancet 2005; 366: 726-32 [pdf]
"A while ago I wrote a comment on an article that was published in Homeopathy. This article, among other things, purported to show that the authors of a Lancet meta-analysis (Aijing Shang and co-workers) that had negative results for homeopathy had engaged in post-hoc hypothesising and data dredging. That was an outrageous slur on what is a perfectly reasonable paper, if you understand it properly. My comment has now been published, along with a response from the authors…the reply by original authors Rutten and Stolper is an exercise in evasion and obfuscation, and doesn't really address most of the points that I made." The article concludes that there is still no reason to think that there is anything particularly wrong with the Shang et al. Lancet paper, and there is certainly no excuse for accusing its authors of research misconduct." Paul Wilson, Hawk-Handsaw Blogspot ( 8th April 2009)
"There seems to be a persistent myth among homeopathic apologists that the final eight homeopathic studies (large and of high quality) analysed in the famous Lancet paper by Shang et al. are somehow secret… So, finally, let's dispel this particular piece of homeomythology: the identity of the final eight, high quality relatively large, homeopathic trials selected by Shang et al. are not secret. They have been in the public domain for nearly two years." The identities of the studies are revealed in this article. Apgaylard (28th November 2007)
"The Lancet action will add substantially to the growing pressure upon NICE and the Department of Health to answer concerns from the medical profession over double standards in requirements for evidence of safety and efficacy of treatments. According to a recent Guardian article, around 42% of GPs in England will consider referring patients to a homoeopath, while in Scotland as many as 86% are said to be in favour of the 250-year-old holistic therapy." Healthwatch-UK Newsletter No.59 (October 2005)
"A leading medical journal [The Lancet] has made a damning attack on homeopathy saying it is no better than dummy drugs. …A Swiss-UK review of 110 trials found no convincing evidence the treatment worked any better than a placebo." BBC News (26th August 2005) [NOTE: The Lancet Editorial, entitled 'The End of Homoeopathy', said: "That homoeopathy fares poorly when compared with allopathy in Aijing Shang and colleagues' systematic evaluation is unsurprising. Of greater interest is the fact that this debate continues, despite 150 years of unfavourable findings. The more dilute the evidence for homoeopathy becomes, the greater seems its popularity. For too long, a politically correct laissez-faire attitude has existed towards homoeopathy… Going one step further, the Swiss Government, after a 5-year trial, has now withdrawn insurance coverage for homoeopathy and four other complementary treatments because they did not meet efficacy and cost-effectiveness criteria… Surely the time has passed for selective analyses, biased reports, or further investment in research to perpetuate the homoeopathy versus allopathy debate. Now doctors need to be bold and honest with their patients about homoeopathy's lack of benefit, and with themselves about the failing of modern medicine to address patients' needs for personalised care". The paper draws the following conclusion: "Interpretation: Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects".]
"The Lancet today (Wednesday August 31, 2005) calls on the Department of Health and the National Institute of Health and Clinical Excellence (NICE) to urgently consider developing guidelines on the use of homeopathic remedies. The request comes after the publication of a research paper in the journal (Lancet 2005; 366:726-32), which showed that homeopathic remedies are no better than a placebo. Richard Horton, Editor of The Lancet, in a letter to Professor Sir Michael Rawlins, Chairman of NICE, writes that without guidance on the use on homeopathic remedies there will continue to be inappropriate practice throughout the NHS. Dr Horton states: "The formulation of guidance based on an appraisal of homeopathy's effects would help to promote the best possible improvement in patient care for the given NHS resources available. NICE guidance would add substantially to the debate about whether and to what extent homeopathy should be available on the NHS. There is now a sufficient evidence base on which to decide such guidance. Moreover, there is strong reason to believe that, in the absence of such guidance, there will continue to be inappropriate practice throughout the NHS . . . Given the controversy and inevitable uncertainty surrounding homeopathic medicine, this subject is a matter of urgent public concern." The Lancet press office T) +44 (0)207 424 4949/4249." [Press Releases available on request via this link]