Efficacy of homoeopathic treatment: Systematic review of meta-analyses of randomised placebo-controlled homoeopathy trials for any indication.

BACKGROUND AND OBJECTIVE: Since 1997, several meta-analyses (MAs) of placebo-controlled randomised efficacy trials of homoeopathy for any indication (PRETHAIs) have been published with different methods, results and conclusions. To date, a formal assessment of these MAs has not been performed. The main objective of this systematic review of MAs of PRETHAIs was to evaluate the efficacy of homoeopathic treatment. METHODS: The inclusion criteria were as follows: MAs of PRETHAIs in humans; all ages, countries, settings, publication languages; and MAs published from 1 Jan. 1990 to 30 Apr. 2023. The exclusion criteria were as follows: systematic reviews without MAs; MAs restricted to age or gender groups, specific indications, or specific homoeopathic treatments; and MAs that did not assess efficacy. We searched 8 electronic databases up to 14 Dec. 2020, with an update search in 6 databases up to 30 April 2023. The primary outcome was the effect estimate for all included trials in each MA and after restricting the sample to trials with high methodological quality, according to predefined criteria. The risk of bias for each MA was assessed by the ROBIS (Risk Of Bias In Systematic reviews) tool. The quality of evidence was assessed by the GRADE framework. Statistical analyses were performed to determine the proportion of MAs showing a significant positive effect of homoeopathy vs. no significant difference. RESULTS: Six MAs were included, covering individualised homoeopathy (I-HOM, n = 2), nonindividualised homoeopathy (NI-HOM, n = 1) and all homoeopathy types (ALL-HOM = I-HOM + NI-HOM, n = 3). The MAs comprised between 16 and 110 trials, and the included trials were published from 1943-2014. The median trial sample size ranged from 45 to 97 patients. The risk of bias (low/unclear/high) was rated as low for three MAs and high for three MAs. Effect estimates for all trials in each MA showed a significant positive effect of homoeopathy compared to placebo (5 of 5 MAs, no data in 1 MA). Sensitivity analyses with sample restriction to high-quality trials were available from 4 MAs; the effect remained significant in 3 of the MAs (2 MAs assessed ALL-HOM, 1 MA assessed I-HOM) and was no longer significant in 1 MA (which assessed NI-HOM). DISCUSSION: The quality of evidence for positive effects of homoeopathy beyond placebo (high/moderate/low/very low) was high for I-HOM and moderate for ALL-HOM and NI-HOM. There was no support for the alternative hypothesis of no outcome difference between homoeopathy and placebo. The available MAs of PRETHAIs reveal significant positive effects of homoeopathy beyond placebo. This is in accordance with laboratory experiments showing partially replicable effects of homoeopathically potentised preparations in physico-chemical, in vitro, plant-based and animal-based test systems. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020209661. The protocol for this SR was finalised and submitted on 25 Nov. 2020 and registered on 26 Dec. 2020.

Anthroposophic vs. conventional therapy for chronic low back pain: a prospective comparative study.

OBJECTIVE: To compare anthroposophic treatment (eurythmy, rhythmical massage or art therapy; counselling, anthroposophic medication) and conventional treatment for low back pain (LBP) under routine conditions. METHODS: 62 consecutive outpatients from 38 medical practices in Germany, consulting an anthroposophic (A-) or conventional (C-) physician with LBP of >or= 6 weeks duration participated in a prospective non-randomised comparative study. Main outcomes were Hanover Functional Ability Questionnaire (HFAQ), LBP Rating Scale Pain Score (LBPRS), Symptom Score, and SF-36 after 6 and 12 months. RESULTS: At baseline, LBP duration was > 6 months in 85% (29/34) of A-patients and 54% (15/28) of C-patients (p = 0.004). Unadjusted analysis showed significant improvements in both groups of HFAQ, LBPRS, Symptom Score, SF-36 Physical Component Summary, and three SF-36 scales (Physical Function, Pain, Vitality), and improvements in A-patients of three further SF-36 scales (Role Physical, General Health, Mental Health). After adjustment for age, gender, LBP duration, and education, improvements were still significant in both groups for Symptom Score (p = 0.030), SF-36 Physical Component Summary (p = 0.004), and three SF-36-scales (Physical Function, p = 0.025; Role Physical, p = 0.014; Pain, p = 0.003), and in A-patients for SF-36-Vitality (p = 0.032). Compared to C-patients, A-patients had significantly more pronounced improvements of three SF-36 scales (Mental Health: p = 0.045; General Health: p = 0.006; Vitality: p = 0.005); other improvements did not differ significantly between the two groups. CONCLUSION: Compared to conventional therapy, anthroposophic therapy for chronic LBP was associated with at least comparable improvements.

[Chronic fatigue syndrome--a review of the literature]. / Kronisk tretthetssyndrom--en litteraturoversikt.

Chronic fatigue syndrome is a clinical condition characterized by abnormal fatigue, subfebrile body temperature, sore throat, lymphadenopathy, arthralgia, myalgia and neuropsychiatric symptoms. Typically, the syndrome develops after a flu-like illness and is markedly exacerbated by exercise. The etiology is unknown and there is no single diagnostic test. The patients may have cognitive dysfunction, immunological and endocrinological abnormalities and abnormal mitochondria. Magnetic resonance imaging scans may show increased uptake of signals in the brain, and single photon emission computerized tomography reveals regional hypoperfusion of the brain. The author discusses similarities and distinctions between the syndrome and depression.