Homeopathy (2014) 103, 217e218 Ó 2014 The Faculty of Homeopathy http://dx.doi.org/10.1016/j.homp.2014.09.002, available online at http://www.sciencedirect.com
GUEST EDITORIAL
Knowing what we are talking about: The CORE-Hom database on clinical research in homeopathy is an important advance In 1993, after ten years of deliberation with all healthcare parties, the Dutch Health Board published a report on research in complementary and alternative medicine (CAM).1 One of the recommendations of this 775 pages report was: “. if repeated research according to the recommendations in this report show positive results, then the method should be recognised”. We repeatedly asked what was meant by ‘repeated research’ and what conventional medical methods were recognised on how much research. We never received an answer. Two years earlier, Kleijnen et al had concluded, after reviewing 105 clinical trials of homeopathy: “The amount of positive evidence even among the best studies came as a surprise to us. Based on this evidence we would readily accept that homeopathy can be efficacious, if only the mechanism of action were more plausible . the evidence presented in this review would probably be sufficient for establishing homeopathy as a regular treatment for certain indications”. Maybe we should have made a contract before the first review of homeopathic research was commissioned, but would that have made a difference? The Cochrane handbook for systematic reviews of interventions states: “Review authors’ prior knowledge of the results of a potentially eligible study may, for example, influence the definition of a systematic review question, the subsequent criteria for study eligibility, the choice of intervention comparisons to analyse, or the outcomes to be reported in the review.”.2 It appears that the problem of recognition based on scientific evidence has been underestimated.
A powerfuland comprehensive database There are now more than 230 substantive publications reporting randomised, double blind, controlled trials of homeopathy.3 Thanks to the recently launched CORE-Hom (Clinical Outcome REsearch in Homeopathy) database, created by the Karl und Veronica Carstens-Stiftung in collaboration with the Homeopathy Research Institute (HRI), and described by Jurgen Clausen and colleagues in a paper in this issue, it is now easy and free of charge to search these by quality, indication, design, homeopathic remedy, author and other parameters.4 For instance we can quickly compare Received 15 September 2014; accepted 16 September 2014
the quality ratings across reviews. In Shang et al’s systematic review 110 clinical trials of homeopathy were compared with conventional medicine studies, matched on indication.5 We can now easily compare the quality ratings of Shang et al with those of Linde et al in 66 trials.6 In 12 the two groups rated quality differently: in ten trials Linde rated quality ‘4’ or ‘5’ (scale 0e5), where Shang rated ‘low quality’; in two studies Linde rated ‘3’, where Shang rated ‘high quality’. This search showed what ‘repeated research’ means for homeopathy and that estimates of quality can diverge, confirming the Cochrane caveat. CORE-Hom offers an invaluable summary of existing clinical research in homeopathy, with links to the original paper and existing reviews. Anyone interested can, free of charge, form her/his own opinion about clinical scientific evidence for homeopathy. Hitherto, everybody had to search for the same data, inevitably making subjective choices. We can now proceed to another phase: how can we interpret these data and what should we do with them?
Recognition and dissemination The next discussion is about scientific evidence, not especially about homeopathy. What is required for recognition and where does recognition stand for? How do we fit in RCT evidence in other types of evidence? How important is a theoretical prior chance that something works? Has the probability that a method works increased or not? How important is the effectiveness in daily practice? How do we connect all available evidence? Which was the original research question and what research questions are posthoc? Etc. Information about existing research can also guide us in future research. What are the strengths and weaknesses of homeopathic research? What aspects of the method should be improved? What research has priority and how can we improve future research? The role of scientific evidence in the recognition process is unclear, it also depends on how what information is dispersed. The Carsten-Stiftung (and HRI) is doing a great job in making information about all clinical research publicly available, as it has already done for basic research.7 We can help by referring to these databases, and by using them for future research to build a consistent and complete body of evidence and quality for homeopathy. Lex Rutten
Guest editorial A.L.B. Rutten
218
References 1 Gezondheidsraad. [Alternative modes of treatment and scientific research]. Alternatieve Behandelwijzen en Wetenschappelijk Onderzoek. Den Haag: Gezondheidsraad, 1993. publication nr. 1993/13. 2 Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions, version 5.1, chapter 2.1. http://handbook.cochrane. org/ accessed 7 September 2014. 3 http://www.carstens-stiftung.de/core-hom/index.php. Accessed 8 September 2014. 4 Clausen J, Moss S, Tournier A, L€ udtke R, Albrecht H. CORE-Hom: A powerful and exhaustive database of clinical trials in Homeopathy. Homeopathy 2014; 104. xx-xx.
Homeopathy
5 Shang A, Huwiler-M€ untener K, Nartey L, et al. Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Lancet 2005; 366: 726e732. 6 Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trial. Lancet 1997; 350: 834e843. 7 http://www.carstens-stiftung.de/hombrex/index.php. Accessed 9 September 2014.
ALB Rutten Aard 10, 4813 NN Breda, Netherlands E-mail: [email protected]
GUEST EDITORIAL
Knowing what we are talking about: The CORE-Hom database on clinical research in homeopathy is an important advance In 1993, after ten years of deliberation with all healthcare parties, the Dutch Health Board published a report on research in complementary and alternative medicine (CAM).1 One of the recommendations of this 775 pages report was: “. if repeated research according to the recommendations in this report show positive results, then the method should be recognised”. We repeatedly asked what was meant by ‘repeated research’ and what conventional medical methods were recognised on how much research. We never received an answer. Two years earlier, Kleijnen et al had concluded, after reviewing 105 clinical trials of homeopathy: “The amount of positive evidence even among the best studies came as a surprise to us. Based on this evidence we would readily accept that homeopathy can be efficacious, if only the mechanism of action were more plausible . the evidence presented in this review would probably be sufficient for establishing homeopathy as a regular treatment for certain indications”. Maybe we should have made a contract before the first review of homeopathic research was commissioned, but would that have made a difference? The Cochrane handbook for systematic reviews of interventions states: “Review authors’ prior knowledge of the results of a potentially eligible study may, for example, influence the definition of a systematic review question, the subsequent criteria for study eligibility, the choice of intervention comparisons to analyse, or the outcomes to be reported in the review.”.2 It appears that the problem of recognition based on scientific evidence has been underestimated.
A powerfuland comprehensive database There are now more than 230 substantive publications reporting randomised, double blind, controlled trials of homeopathy.3 Thanks to the recently launched CORE-Hom (Clinical Outcome REsearch in Homeopathy) database, created by the Karl und Veronica Carstens-Stiftung in collaboration with the Homeopathy Research Institute (HRI), and described by Jurgen Clausen and colleagues in a paper in this issue, it is now easy and free of charge to search these by quality, indication, design, homeopathic remedy, author and other parameters.4 For instance we can quickly compare Received 15 September 2014; accepted 16 September 2014
the quality ratings across reviews. In Shang et al’s systematic review 110 clinical trials of homeopathy were compared with conventional medicine studies, matched on indication.5 We can now easily compare the quality ratings of Shang et al with those of Linde et al in 66 trials.6 In 12 the two groups rated quality differently: in ten trials Linde rated quality ‘4’ or ‘5’ (scale 0e5), where Shang rated ‘low quality’; in two studies Linde rated ‘3’, where Shang rated ‘high quality’. This search showed what ‘repeated research’ means for homeopathy and that estimates of quality can diverge, confirming the Cochrane caveat. CORE-Hom offers an invaluable summary of existing clinical research in homeopathy, with links to the original paper and existing reviews. Anyone interested can, free of charge, form her/his own opinion about clinical scientific evidence for homeopathy. Hitherto, everybody had to search for the same data, inevitably making subjective choices. We can now proceed to another phase: how can we interpret these data and what should we do with them?
Recognition and dissemination The next discussion is about scientific evidence, not especially about homeopathy. What is required for recognition and where does recognition stand for? How do we fit in RCT evidence in other types of evidence? How important is a theoretical prior chance that something works? Has the probability that a method works increased or not? How important is the effectiveness in daily practice? How do we connect all available evidence? Which was the original research question and what research questions are posthoc? Etc. Information about existing research can also guide us in future research. What are the strengths and weaknesses of homeopathic research? What aspects of the method should be improved? What research has priority and how can we improve future research? The role of scientific evidence in the recognition process is unclear, it also depends on how what information is dispersed. The Carsten-Stiftung (and HRI) is doing a great job in making information about all clinical research publicly available, as it has already done for basic research.7 We can help by referring to these databases, and by using them for future research to build a consistent and complete body of evidence and quality for homeopathy. Lex Rutten
Guest editorial A.L.B. Rutten
218
References 1 Gezondheidsraad. [Alternative modes of treatment and scientific research]. Alternatieve Behandelwijzen en Wetenschappelijk Onderzoek. Den Haag: Gezondheidsraad, 1993. publication nr. 1993/13. 2 Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions, version 5.1, chapter 2.1. http://handbook.cochrane. org/ accessed 7 September 2014. 3 http://www.carstens-stiftung.de/core-hom/index.php. Accessed 8 September 2014. 4 Clausen J, Moss S, Tournier A, L€ udtke R, Albrecht H. CORE-Hom: A powerful and exhaustive database of clinical trials in Homeopathy. Homeopathy 2014; 104. xx-xx.
Homeopathy
5 Shang A, Huwiler-M€ untener K, Nartey L, et al. Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Lancet 2005; 366: 726e732. 6 Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trial. Lancet 1997; 350: 834e843. 7 http://www.carstens-stiftung.de/hombrex/index.php. Accessed 9 September 2014.
ALB Rutten Aard 10, 4813 NN Breda, Netherlands E-mail: [email protected]
