Homeopathie, wetenschap of kwakzalverij?

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Homeopathie, wetenschap of kwakzalverij?

Berichtdoor Sisyphus » 05 nov 2006, 13:19

Homeopathie, wetenschap of kwakzalverij? Stand van wetenschappelijk onderzoek.

Samenstelling: Koerok, Tom Schoepen, Wim Betz

In de discussie over de werkzaamheid van homeopathie gaat het voornamelijk om randomized clinical trials. Om niet steeds opnieuw op zoek te moeten gaan naar relevante publicaties is het handig om hier een lijst van op te stellen. Drie daarvan worden veelvuldig genoemd (Knipschild, Linde en Ernst). De vierde is de recente meta-analyse, gepubliceerd in The Lancet in augustus 2005. De lijst wordt systematisch uitgebreid en tevens aangevuld met bevestigingen, herroepingen van eerder onderzoek en voorbeelden van bronnenmanipulatie. Iedereen is vrij om argumenten te mailen naar info@skepp.be, alle bijdragen zullen grondig worden geëvalueerd, aanpassingen aan de tekst worden vermeld.

De studies worden steeds onder de volgende vorm gepresenteerd:
Titel

BACKGROUND:
METHODS:
FINDINGS:
CONCLUSIONS:

Auteurs:
Instituut:
Bron:
Gevonden via:
Aanvullende infromatie:
-------------------------------


    September 1997

    Titel: Are the clinical effects of homeopathy placebo effects?
    A meta-analysis of placebo-controlled trials.


    BACKGROUND: Homeopathy seems scientifically implausible, but has widespread use. We aimed to assess whether the clinical effect reported in randomised controlled trials of homeopathic remedies is equivalent to that reported for placebo.
    METHODS: We sought studies from computerised bibliographies and contracts with researchers, institutions, manufacturers, individual collectors, homeopathic conference proceedings, and books. We included all languages. Double-blind and/or randomised placebo-controlled trials of clinical conditions were considered. Our review of 185 trials identified 119 that met the inclusion criteria. 89 had adequate data for meta-analysis, and two sets of trial were used to assess reproducibility. Two reviewers assessed study quality with two scales and extracted data for information on clinical condition, homeopathy type, dilution, "remedy", population, and outcomes.
    FINDINGS: The combined odds ratio for the 89 studies entered into the main meta-analysis was 2.45 (95% CI 2.05, 2.93) in favour of homeopathy. The odds ratio for the 26 good-quality studies was 1.66 (1.33, 2.08 ), and that corrected for publication bias was 1.78 (1.03, 3.10). Four studies on the effects of a single remedy on seasonal allergies had a pooled odds ratio for ocular symptoms at 4 weeks of 2.03 (1.51, 2.74). Five studies on postoperative ileus had a pooled mean effect-size-difference of -0.22 standard deviations (95% CI -0.36, -0.09) for flatus, and -0.18 SDs (-0.33, -0.03) for stool (both p < 0.05).
    CONCLUSIONS: The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.

    Auteurs: Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB.
    Instituut: Munchener Modell, Centre for Complementary Medicine Research, Technische Universitat/Ludwig-Maximillans-Universitat, Munchen, Germany.
    Bron: Lancet. 1997 Sep 20;350(9081):834-43.
    Gevonden via: PubMed (link)




    December 2002

    Titel: A systematic review of systematic reviews of homeopathy.

    BACKGROUND: Homeopathy remains one of the most controversial subjects in therapeutics. This article is an attempt to clarify its effectiveness based on recent systematic reviews.
    METHODS: Electronic databases were searched for systematic reviews/meta-analysis on the subject. Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis.
    FINDINGS: Collectively they implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data. Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo.
    CONCLUSIONS: In conclusion, the hypothesis that any given homeopathic remedy leads to clinical effects that are relevantly different from placebo or superior to other control interventions for any medical condition, is not supported by evidence from systematic reviews. Until more compelling results are available, homeopathy cannot be viewed as an evidence-based form of therapy.

    Auteurs: Ernst E.
    Instituut: Department of Complementary Medicine, School of Sport & Health Sciences, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT UK. E.Ernst@exeter.ac.uk
    Bron: Br J Clin Pharmacol. 2002 Dec;54(6):577-82.
    Gevonden via: PubMed (link <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=pubmed&amp;dopt=Abstract&amp;list_uids=12492603&amp;itool=iconabstr&amp;query_hl=11> )
    Volledige artikel: BJCP (link <http://www.blackwell-synergy.com/links/doi/10.1046/j.1365-2125.2002.01699.x/full/> )

    Extra informatie:
    Het onderzoek werd besproken in Skepter 16, maart 2003 <http://www.skepsis.nl/homeopathie.html> .




    Augustus 2005

    Titel: Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy.

    BACKGROUND: Homoeopathy is widely used, but specific effects of homoeopathic remedies seem implausible. Bias in the conduct and reporting of trials is a possible explanation for positive findings of trials of both homoeopathy and conventional medicine. We analysed trials of homoeopathy and conventional medicine and estimated treatment effects in trials least likely to be affected by bias.
    METHODS: Placebo-controlled trials of homoeopathy were identified by a comprehensive literature search, which covered 19 electronic databases, reference lists of relevant papers, and contacts with experts. Trials in conventional medicine matched to homoeopathy trials for disorder and type of outcome were randomly selected from the Cochrane Controlled Trials Register (issue 1, 2003). Data were extracted in duplicate and outcomes coded so that odds ratios below 1 indicated benefit. Trials described as double-blind, with adequate randomisation, were assumed to be of higher methodological quality. Bias effects were examined in funnel plots and meta-regression models.
    FINDINGS: 110 homoeopathy trials and 110 matched conventional-medicine trials were analysed. The median study size was 65 participants (range ten to 1573). 21 homoeopathy trials (19%) and nine (8%) conventional-medicine trials were of higher quality. In both groups, smaller trials and those of lower quality showed more beneficial treatment effects than larger and higher-quality trials. When the analysis was restricted to large trials of higher quality, the odds ratio was 0.88 (95% CI 0.65-1.19) for homoeopathy (eight trials) and 0.58 (0.39-0.85) for conventional medicine (six trials).
    CONCLUSIONS: 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.

    Auteurs: Shang A, Huwiler-Muntener K, Nartey L, Juni P, Dorig S, Sterne JA, Pewsner D, Egger M.
    Instituut: Department of Social and Preventive Medicine, University of Berne, Berne, Switzerland.
    Bron: Lancet. 2005 Aug 27-Sep 2;366(9487):726-32.
    Gevonden via: PubMed (link <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=pubmed&amp;dopt=Abstract&amp;list_uids=16125589&amp;itool=iconabstr&amp;query_hl=13> )


      The Lancet : homeopathie werkt echt niet

      Homeopatische middelen werken niet en de discussie hierover moet voor eens en voor altijd afgelopen zijn. Dat meldt het toonaangevende Britse medische tijdschrift The Lancet op basis van uitgebreide studies. Britse en Zwitserse wetenschappers hebben 110 onderzoeken (niet proefpersonen zoals Belga foutief meldt) naar het effect van homeopatische middelen en therapieën opnieuw bekeken. Ze vonden geen bewijs dat de pillen en druppeltjes beter werken dan een placebo.
      In een commentaar onder de kop Het einde van de homeopathie dringt The Lancet er bij artsen op patiënten te vertellen dat homeopathische middelen een zinloos tijdverdrijf zijn. In november vorig jaar forceerden Belgische homeopaten in ons land nog een persbericht dat 10 Europese wetenschappers het bewijs van de werking van homeopathie zouden geleverd hebben. Dit bericht bleek toen ongecontroleerd en voorbarig.
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Sisyphus
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Re: Homeopathie, wetenschap of kwakzalverij?

Berichtdoor willem_betz » 06 jul 2011, 00:34

en buitenkansje:
Het tijdschrift FACT (Focus on Alternative and Complementary Therapies) stelt een volledig nummer over homeopathie gratis ter beschikking online: http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%292042-7166/homepage/custom_copy.htm
Geloof je alle nonsens, of sommige niet? Hoe maak je het onderscheid?
De hevigste missionarissen en propagandisten voor kwakzalvers zijn vaak hun slachtoffers zelf.
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