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Clarification of results

Posted by DanaUllman on 09 Feb 2013 at 21:00 GMT

It is puzzling why the authors choose to summarize the results of this trial as, “The effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema.” It would have been equally accurate to say,

“Homeopathic treatment and conventional medical treatment were found to be equally effective for children with mild to moderate atopic eczema.”

Because skeptics of homeopathy do not expect ANY possible benefits from homeopathic treatment, this trial provided evidence that there are benefits when homeopathic treatment is added to the variety of care that patients receive. Further, this trial showed that there was a non-significant trend towards better results during the first 12 months for children receiving conventional medical care but a non-significant trend towards better results during months 24 and 36 for children receiving homeopathic treatment. The typical placebo response is notably different from the response that the children in this trial who received homeopathy experienced.

It should also be noted that the researchers discovered that there were some baseline differences between the two groups: patients in the homeopathic group showed more severe SCORAD scores (which was the MAIN OUTCOME measure of this study) and a trend to a longer symptom duration, while the TIS (three item severity) score was higher in the conventional group. Also, there were higher baseline costs in the homoeopathic group.

The researchers found that there were greater costs in the homeopathic group, though unless I’m mis-reading the report, the total costs for the homeopathic care was around 200 Euros as compared with 69 Euros for conventional medical care (I’m not fully clear if this cost difference was per patient or for the entire group, though whatever it is, many parents and possibly some governments may consider this higher price to be worth the value for a safer treatment). The fact that the researchers found evidence of a reduction in costs for the homeopathic group over time may give additional benefits to this mode of treatment. Further, the researchers found that 8.2% of the conventionally treated group experienced an adverse event, as compared with only 5.3% in the homeopathic treated group (this difference was not statistically significant, nor was the one hospitalization in the conventionally treated group, compared with none in the homeopathic group; however, this trend of benefits to the homeopathic group should be considered when evaluating treatment from a systems perspective).

The fact that the researchers found 18% of the conventional group were prescribed “potent corticosteroids” as compared with only 7.9% of the homeopathic group suggests that over time there is likely to be a higher incidence of adverse events and possibly increased hospitalizations in the conventional group. Such long-term observations might also find significantly increased costs associated with the conventionally treated group.

Competing interests declared: I have written numerous books on homeopathic medicine and have a company that sells homeopathic books and medicines.

RE: Clarification of results

StephanieRoll replied to DanaUllman on 11 Feb 2013 at 11:58 GMT

Thank you for taking interest in our study.
Our conclusion that “homoeopathic treatment were not superior to conventional treatment” stems from the fact that the design and hypothesis of our study were chosen to show a difference between the two treatment groups, not equivalence or non-inferiority. “not superior” is NOT the same as “equally effective”. A trial to show equality would need another design, sample size and analysis. See for example Altman &Bland, Absence of evidence is not evidence of absence. BMJ 1995;311:485.

Competing interests declared: I am the author of the publication.