Reinterpreting homoeopathy in the light of placebo effects to manage patients who seek homoeopathic care: A systematic review

Abstract

Homoeopathy is widespread, and users claim to benefit from it. However, clear evidence of its efficacy over placebo is not available to date. As a consequence, a social separation between homoeopathy users and mainstream medicine exists, exposing these patients to many risks. Our primary objective is to assess homoeopathy efficacy by systematically reviewing existing systematic reviews and meta-analyses and to systematically review trials on open-label placebo (OLP) treatments. A secondary objective is to understand if homoeopathy as a whole may be considered as a placebo treatment. PubMed/Medline, Embase, Google Scholar, and Cochrane Library were systematically searched for systematic reviews and meta-analyses on homoeopathy efficacy, and 61 studies were included. Same databases plus Journal of Interdisciplinary Placebo Studies (JIPS) were also systematically searched for randomised controlled trials (RCTs) on OLP treatments, and 10 studies were included. Databases were searched up to 24 February 2018. Two authors independently screened all retrieved articles and selected studies eligible for inclusion. The quality of reviews of included studies was evaluated with a dedicated NIH tool in the first review, whereas the risk of bias of trials of included studies was assessed with the specific Cochrane tool in the second review.Qualitative syntheses show that homoeopathy efficacy can be considered comparable to placebo, and that OLP treatments may be effective in some health conditions. Placebo effects like placebo itself, treatment context, physician-patient relationship, and other nonspecific factors can define the idea of placebo treatments, which may be effective in some conditions. If homoeopathy efficacy is comparable to placebo, and if placebo treatments can be effective in some conditions, then homoeopathy as a whole may be considered as a placebo treatment. Reinterpreting homoeopathy as a placebo treatment would define limits and possibilities of this practice. This perspective shift suggests a strategy to manage patients who seek homoeopathic care and to reconcile them with mainstream medicine in a sustainable way. K E Y W O R D S complementary and alternative medicine, homoeopathy, open-label placebo, patientphysician relationship, placebo effects, placebo treatment

Narrative Medicine Meets Planetary Health: Mindsets Matter in the Anthropocene

“…This period also marked a massive rise in the popularity of alternative systems of healing; many scholars interpreted this as a surrogate marker for some of the deficits in the biomedicine-dominated practice of Western medicine [23]. The study of alternative systems of medicine is, by-and-large, the realm of placebo studies [24]. We will turn our attention to placebo and its connection to storytelling in more detail later.…”

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“…In a recent systematic literature review summarizing evidence from over 60 reviews, the efficacy of homeopathy was analyzed along with effects of open-label placebo treatments (namely the administration of a pharmacologically inert substance without deception) in order to find a possible way to reinterpret homeopathy in the light of available scientific evidence [32]. Overall, it appears that the efficacy of homeopathy is comparable to placebo, and clinical trials about open-label placebo treatments show their efficacy for the symptomatic management of some health conditions, such as pain, nausea, irritable bowel syndrome, fibromyalgia, hypertension, hyperactive bladder, insomnia, depression, some sexual dysfunctions, osteoarthritis symptoms, and the restless leg syndrome [32].…”

“…To date, available high-quality scientific evidence from existing umbrella reviews shows that homeopathy efficacy isn't clearly superior to placebo, even when considering individualized homeopathy, in which the remedy is chosen not only on the basis of the disease type, but also depending on all subjective symptoms/manifestations reported by the patient [26,31,32]. Extensive literature reviews from the Australian Health and Medical Research Council, from the British National Healthcare System, and from the European Academies' Scientific Advisory Council point towards the same direction [33][34][35].…”

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“…Homeopathy use worldwide ranges from 0.7 to 9.8% (12-month prevalence; median: 3.9%). Empirical evidence suggests that homeopathy does not work beyond the placebo effect (Antonelli and Donelli, 2018). This leads to an ethical dilemma: the prescription of homeopathic remedies can be seen as deceptive, when it is recommended as an effective medication (Shaw, 2015).…”