Homeopathy - not even a particularly good placebo

[Mojo]

One of the things often said in defence of homoeopathy is that even if it works via the placebo effect, it still provides relief to the patient. It is suggested that, in individualised (or "Classical") homoeopathy, the extended consultation makes it a particularly effective placebo. It is also suggested "that randomised, placebo-controlled clinical trials (RCTs) of classical (individualised) homeopathy often fail because placebo effects are substantially higher than in conventional medicine" (see abstract cited below).

It seems that this may not be the case: see Nuhn T, Lüdtke R, Geraedts M. Placebo effect sizes in homeopathic compared to conventional drugs - a systematic review of randomised controlled trials. Homeopathy. 2010 Jan;99(1):76-82.

CONCLUSIONS: Placebo effects in RCTs on classical homeopathy did not appear to be larger than placebo effects in conventional medicine.

You can get the same degree of placebo effect, it appears, without all that mucking about with recording of symptoms, history taking, miasms, etc.

 

[Safe-Keeper]

Nothing we didn't already know.
Homeopathy brigade arrives in 3... 2... 1...

 

[Rolfe]

Well, if they can only get 70% of patients to say they feel at least "a little" better, when asked face-to-face by the homoeopath they have chosen to consult, at a time chosen by the homoeopath, I'd say they're not doing so good.

Rolfe.

 

[Kumar]

Whether placebo effect is also there in conventional medicines?

If there, can we accept that even here many patients get treatment just by placebo(obiously along with indicated side/adverse effects which also make them visible?

 

[geni]

One of the things often said in defence of homoeopathy is that even if it works via the placebo effect, it still provides relief to the patient. It is suggested that, in individualised (or "Classical") homoeopathy, the extended consultation makes it a particularly effective placebo. It is also suggested "that randomised, placebo-controlled clinical trials (RCTs) of classical (individualised) homeopathy often fail because placebo effects are substantially higher than in conventional medicine" (see abstract cited below).

It seems that this may not be the case: see Nuhn T, Lüdtke R, Geraedts M. Placebo effect sizes in homeopathic compared to conventional drugs - a systematic review of randomised controlled trials. Homeopathy. 2010 Jan;99(1):76-82.




You can get the same degree of placebo effect, it appears, without all that mucking about with recording of symptoms, history taking, miasms, etc.

Hmm since people in trials general get more attention than normal anyway it may not be the best of comparisons.

 

[Mojo]

Whether placebo effect is also there in conventional medicines?

Try reading the abstract I linked to in the OP, or even the passage I quoted from it.

 

[Mojo]

Hmm since people in trials general get more attention than normal anyway it may not be the best of comparisons.

On the other hand they (presumably) also know that they might be given a placebo.

 

[SpuriusMaximus]

Actually, I remember reading about a study or metastudy some time ago, IIRC on badscience.net, where it turns out that the placebo effect may not really exist in true medicine either. Turned out that in the longer term, there was no difference between those given a placebo and those told to just wait it out.

 

[blutoski]

Actually, I remember reading about a study or metastudy some time ago, IIRC on badscience.net, where it turns out that the placebo effect may not really exist in true medicine either. Turned out that in the longer term, there was no difference between those given a placebo and those told to just wait it out.

This is the case, and I'm a bit of a stick-in-the-mud about it, as even many skeptics have absorbed the cultural 'fact' of placebo effects being significant. I actually think Dr. Hall is misinforming skeptics on this topic by sensationalizing unreplicated outlier studies.

The research is focussed on comparing gains in a placebo group compared to either a waitlist group or nontreatment baseline changes for the condition. There is some evidence of slight differences for some types of mild pain and nausea.

The best quality literature review of this type is ongoing, and reports through Cochrane: [Placebo interventions for all clinical conditions]

 

[blutoski]

One of the things often said in defence of homoeopathy is that even if it works via the placebo effect, it still provides relief to the patient. It is suggested that, in individualised (or "Classical") homoeopathy, the extended consultation makes it a particularly effective placebo. It is also suggested "that randomised, placebo-controlled clinical trials (RCTs) of classical (individualised) homeopathy often fail because placebo effects are substantially higher than in conventional medicine" (see abstract cited below).

It seems that this may not be the case: see Nuhn T, Lüdtke R, Geraedts M. Placebo effect sizes in homeopathic compared to conventional drugs - a systematic review of randomised controlled trials. Homeopathy. 2010 Jan;99(1):76-82.




You can get the same degree of placebo effect, it appears, without all that mucking about with recording of symptoms, history taking, miasms, etc.

My impression is that they are saying the placebo arm in their clinical trials looks the same as a placebo arm in a drug clinical trial. This makes sense. This is what I would have predicted, too.

They are not claiming that homeopathy works as well as a placebo - their clinical trials show homeopathy works better than placebo, which is why they endorse it.

What the study is attempting to address is the claim that homeopathic rct placebo arms have better recovery rates than drug rct placebo arms. The study refutes this hypothesis.

 

[Mojo]

My impression is that they are saying the placebo arm in their clinical trials looks the same as a placebo arm in a drug clinical trial. This makes sense. This is what I would have predicted, too.

It's what I would have predicted as well.

What the study is attempting to address is the claim that homeopathic rct placebo arms have better recovery rates than drug rct placebo arms. The study refutes this hypothesis.

Well, actually they seem to have been trying to refute the claim that RCTs of homoeopathy fail because there is a better than expected response in the placebo arm:

It has been hypothesised that randomised, placebo-controlled clinical trials (RCTs) of classical (individualised) homeopathy often fail because placebo effects are substantially higher than in conventional medicine.

So another excuse bites the dust.

 

[Mojo]

The research is focussed on comparing gains in a placebo group compared to either a waitlist group or nontreatment baseline changes for the condition. There is some evidence of slight differences for some types of mild pain and nausea.

i.e. precisely those types of condition in which there is inevitably going to be a subjective or psychological component.

 

[blutoski]

It's what I would have predicted as well.




Well, actually they seem to have been trying to refute the claim that RCTs of homoeopathy fail because there is a better than expected response in the placebo arm:


So another excuse bites the dust.

Ah, I see. You're right. Bummer for homeopathy.

 

[blutoski]

i.e. precisely those types of condition in which there is inevitably going to be a subjective or psychological component.

Well, the authors are trying to avoid subjectivity by concentrating on binary outcome trials.

But the interesting thing to me is that mild pain and nausea are only a tiny slice of conditions that have a psychological component - consider mood disorders, which show no placebo benefit over nontreatment in this literature base.

What the authors speculate is that mild pain and nausea reporting may actually be influenced more by the white coat factor - falsely reporting improvement to please the caregiver. The theory is that falsely reporting improvement in severe pain or depression carries obvious costs for the patient, so they are less motivated to do so, and it doesn't manifest in the data.

 

[casebro]

My impression is that they are saying the placebo arm in their clinical trials looks the same as a placebo arm in a drug clinical trial.

Aha!!! Homeopathy is shown to be just as good as Allopathic medicine!