Individualized Homeopathy

David Brulé et al. (2024) · Journal of integrative and complementary medicine

This randomized trial of 146 treated children and adolescents with attention-deficit/hyperactivity disorder (ADHD) explored whether homeopathy helps manage the condition, and which part of the treatment might be responsible. ADHD is a neurodevelopmental condition marked by inattention, hyperactivity and impulsivity, and roughly 30% of diagnosed children do not respond to standard medication or behavioral treatment. Homeopathy uses highly diluted natural substances prescribed one patient at a time, and in practice it combines a long consultation with a chosen remedy. Earlier open-label results could not tell those two components apart, so this study separated them. Children aged 6 to 16 in Toronto, Canada were randomly assigned to one of three groups. One group (47 children) received homeopathic consultations plus an individualized remedy, a second (48 children) received the same consultations plus a look-alike placebo granule, and a third (51 children) continued usual care only. Consultations lasted up to two hours at intake and recurred about monthly for 28 weeks. Parents rated symptoms with the Conners 3 Global Index-Parent T-score, where lower scores mean fewer symptoms. Symptom scores fell by about 6.2 points in the remedy group and 6.4 points in the placebo group, compared with 2.2 points in usual care (complete-case analysis, 126 children). After adjustment, the remedy-plus-consultation group differed from usual care (p=0.037), while the placebo-plus-consultation group fell just short of the corrected significance threshold (p=0.026 against a cutoff of 0.025). The two consultation groups did not differ from each other (p=0.93). A clinically meaningful improvement (a drop of at least 7.36 Conners T-score points) occurred in 35.9%, 44.2% and 13.6% of the three groups respectively (p=0.006). Parents in both consultation groups also reported better coping (p=0.012 and p=0.003). Side effects were all mild (Grade 1), mainly increased hyperactivity, emotional outbursts and tics, and did not differ between groups. Because the remedy and placebo groups improved similarly, the authors attribute the benefit to the consultation rather than the remedy itself. Participants knew whether they were receiving consultations, parents scored the main outcome, and recruitment fell short of the planned 177 because the COVID-19 pandemic halted trials, so expectation effects and limited statistical power remain possible. The authors recommend further research into the mechanism and into whether other forms of consultation or psychological support produce comparable results.

H J Hamre et al. (2023) · Systematic reviews

This systematic review examined six earlier meta-analyses (statistical pooling studies) of placebo-controlled randomized trials of homeopathy for any health condition in humans, asking whether homeopathy shows an effect beyond placebo. Homeopathy is built on drug provings (recording symptoms in healthy people), the principle that a substance causing a symptom pattern is used to treat a similar one, and potentization, which means serial dilution with vigorous shaking. Because the six meta-analyses, published between 1997 and 2017, used different methods and reached different conclusions, the authors reviewed them together under a published protocol and judged their risk of bias and the certainty of the overall evidence. The authors searched eight databases plus a private collection and contacted experts, identifying 16 reports covering six meta-analyses, with searches running to December 2020 and an update to April 2023. Two reviewers screened and extracted data independently. The meta-analyses together covered 310 trials or trial comparisons (182 distinct trials published between 1943 and 2014), most often on respiratory conditions such as allergic rhinitis and influenza. Each meta-analysis was rated for risk of bias with ROBIS, and the combined evidence was graded with a GRADE-based approach. All five meta-analyses with reported pooled estimates found a significant effect favouring homeopathy across all trials, for example an odds ratio of 2.45 (95% CI 2.05-2.93) across 89 trials in the 1997 analysis and a standardized mean difference of 0.33 (0.21-0.44) across 54 non-individualised trials in 2017. When only high-quality trials were kept, three of four analyses stayed significant, but the 2017 analysis did not (SMD 0.18, -0.09 to 0.46, 3 trials). Only 6-29% of trials met each analysis's high-quality criteria. Three analyses showed significant heterogeneity and funnel plot asymmetry, a pattern that can signal publication or small-study bias; individualised homeopathy showed neither. Two analyses that combined quality and trial-size restrictions found no significant difference from placebo. Three meta-analyses were rated low and three high risk of bias. The authors rated evidence certainty as high for individualised homeopathy and moderate for the other categories. The authors conclude that the data do not support the hypothesis of no difference from placebo and that placebo-controlled evidence gives no justification for regulatory action against homeopathy. The review only covers trials already in six meta-analyses, so trials after 2011 (individualised) and 2014 (non-individualised) are missing. It also reports no indication-specific results, and its use of GRADE tested whether any effect exists rather than how large it is. The authors recommend updating the individualised homeopathy analysis and studying specific non-individualised treatments for specific conditions.