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Letters to the Editor
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Complementary medicine
Unbalanced opinion
From Mr R. T. Mathie, PhD, and Mr L. R. Kayne, MRPharmS
Edzard Ernst’s (PDF 45K) article (PJ, 27 November, p795)
presents neither a balanced nor a penetrating view of the research literature
in complementary
medicine. In particular, his comments on the clinical trial evidence
for, or against, homoeopathy are flawed in several important ways. He
omits to mention the many trials that point to a homoeopathic treatment
effect above that of placebo1 and he fails to cite a major meta-analysis
whose findings were “incompatible with the hypothesis that the
clinical effects of homoeopathy are completely due to placebo”.2
Moreover, Professor Ernst does not address the point that key differences
in trial design should probably apply when testing a single remedy as
opposed to individualised therapy. By his own admission,3 many arnica
trials have been “burdened with severe methodological flaws”,
so the results he refers to are certainly not “rigorous”!
Professor Ernst’s own trial on carpal-tunnel syndrome actually
had positive trends in favour of arnica (though he reported them as negative),4 and there are several other positive reports in the arnica literature.5,6 Negative studies do exist.7 The jury is still out. We need more and better
research, not unbalanced opinion on earlier failings.
To a greater extent than many people might expect, homoeopathy has been
shown to have an effect above placebo. There is insufficient quality
evidence in the arnica literature upon which to draw sweeping conclusions
either way.
Robert T. Mathie
Lee R. Kayne
Faculty of Homoeopathy
Luton,
Bedfordshire
References
1. Mathie RT. The research evidence base for homeopathy: a fresh assessment
of the literature. Homeopathy 2003;92:84–91.
2. Linde K, Clausius N, Ramirez G et al. Are the clinical effects of
homeopathy placebo effects? A meta-analysis of placebo-controlled trials.
The Lancet 1997;350:834–43.
3. Ernst E, Pittler MH. Efficacy of homeopathic arnica: a systematic
review of placebo-controlled clinical trials. Archives of Surgery 1998;133:1187–90.
4. Stevinson C, Devaraj VS, Fountain-Barber A et al. Homeopathic arnica
for prevention of pain and bruising: randomized placebo-controlled trial
in hand surgery. Journal of the Royal Society of Medicine 1993;96:60–5.
5. Tveiten D, Bruseth S, Borchgrevink CF, Norseth J. Effects of the homoeopathic
remedy Arnica D30 on marathon runners: a randomized, double-blind study
during the 1995 Oslo Marathon. Complementary Therapies in Medicine 1998;6:71–4.
6. Dorfman P, Amodeo C, Riccioti F et al. Evaluation de l’activité d’arnica
5CH sur les troubles veineux après perfusion prolongee. Cahiers
Biotherapie 1988;98 (Suppl):77–82.
7. Kaziro GS. Metronidazole (Flagyl) and Arnica Montana in the prevention
of post-surgical complications, a comparative placebo controlled clinical
trial. British Journal of Oral and Maxillofacial Surgery 1984;22:42–9.
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EDZARD ERNST replies:
This comment raises interesting points which
merit a reply. The aim of my article was not to provide “a balanced
or a penetrating view of the research literature in CM” but to
discuss the question whether we should use powerful placebos (see title
of the article).
I used arnica merely as an example and clearly stated this point.
The correspondents cite “a major meta-analysis” but omits to mention that the authors
of this paper later reanalysed their data and concluded that “there was
clear evidence that studies with better methodological quality tended to yield
less positive results”.1 I also did
not state that all arnica trials were rigorous; some, however, were good
enough to be reasonably conclusive.
The correspondents are correct in pointing out that some studies are negative
while others are positive. This is precisely the reason why a systematic
review generates more reliable overall information than single studies. Two
independent
systematic reviews of arnica are available; sadly both fail to show that
homoeopathic arnica is more than a placebo. This is why I used arnica (and
not homoeopathy
in general) as an example. No sweeping conclusions were drawn other than “we
should use the placebo effect wisely”. Reference
1. Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB.
Impact of study quality on outcome in placebo controlled trials of homoeopathy.
Journal of Clinical Epidemiology 1999;52:631–6. |
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